Provider Demographics
NPI:1871671420
Name:CHAN, DANIEL M (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:CHAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:MARTIN
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:2501 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3204
Mailing Address - Country:US
Mailing Address - Phone:714-633-1011
Mailing Address - Fax:714-633-4883
Practice Address - Street 1:2501 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3204
Practice Address - Country:US
Practice Address - Phone:714-633-1011
Practice Address - Fax:714-633-4883
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS87573Medicare UPIN