Provider Demographics
NPI:1972591378
Name:CHAN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3285 SKYPARK DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5004
Mailing Address - Country:US
Mailing Address - Phone:310-750-3300
Mailing Address - Fax:310-750-3381
Practice Address - Street 1:3285 SKYPARK DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5004
Practice Address - Country:US
Practice Address - Phone:310-750-3300
Practice Address - Fax:310-750-3381
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43553207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
830000407OtherRAILROAD MEDICARE
00G435530OtherBLUE SHIELD
WG43553CMedicare ID - Type Unspecified
A89782Medicare UPIN
830000407OtherRAILROAD MEDICARE