Provider Demographics
NPI:1619095528
Name:CHAN, PHILIP B (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:B
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:BOONHAW
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8222 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4931
Mailing Address - Country:US
Mailing Address - Phone:714-745-0135
Mailing Address - Fax:714-848-9895
Practice Address - Street 1:8222 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4931
Practice Address - Country:US
Practice Address - Phone:714-745-0135
Practice Address - Fax:714-848-9895
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG26197Medicare UPIN