Provider Demographics
NPI:1790018661
Name:LAWRENCE W CHAN M D INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LAWRENCE W CHAN M D INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-738-0378
Mailing Address - Street 1:990 W FREMONT AVE STE W
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3065
Mailing Address - Country:US
Mailing Address - Phone:408-738-0378
Mailing Address - Fax:408-738-0318
Practice Address - Street 1:990 W FREMONT AVE STE W
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3065
Practice Address - Country:US
Practice Address - Phone:408-738-0378
Practice Address - Fax:408-738-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty