Provider Demographics
NPI:1821101916
Name:CHAN, LESLIE CANH (PA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CANH
Last Name:CHAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:5440 THORNWOOD DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1217
Practice Address - Country:US
Practice Address - Phone:408-281-9901
Practice Address - Fax:408-281-3678
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABL506ZMedicare PIN