Provider Demographics
NPI:1790750743
Name:CHAN, STEVE LI (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:LI
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:660 N. DIAMOND BAR BLVD #118
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1034
Mailing Address - Country:US
Mailing Address - Phone:909-612-5835
Mailing Address - Fax:909-612-5836
Practice Address - Street 1:660 N. DIAMOND BAR BLVD #118
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-612-5835
Practice Address - Fax:909-612-5836
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA63015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A630150Medicaid
CA00A630150Medicaid
CAG80466Medicare UPIN