Provider Demographics
NPI:1902209406
Name:ROGER S CHAN
Entity Type:Organization
Organization Name:ROGER S CHAN
Other - Org Name:LAS TUNAS ACUPUNCTURE & HERBS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:626-285-6373
Mailing Address - Street 1:206 E LAS TUNAS DR
Mailing Address - Street 2:#1
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1411
Mailing Address - Country:US
Mailing Address - Phone:626-285-6373
Mailing Address - Fax:626-285-6373
Practice Address - Street 1:206 E LAS TUNAS DR
Practice Address - Street 2:#1
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1411
Practice Address - Country:US
Practice Address - Phone:626-285-6373
Practice Address - Fax:626-285-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC5600OtherACUPUNCTURE