Provider Demographics
NPI:1154367993
Name:CHAN, RONALD (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA829472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH83014Medicare UPIN
CA00A8294712Medicare PIN
CA00A8294720Medicare PIN
CA00A8294715Medicare PIN
CA00A829473Medicare PIN
CA00A829476Medicare PIN
CA00A829477Medicare PIN
CA00A829471Medicare PIN
CA00A8294710Medicare PIN
CA00A8294713Medicare PIN
CA00A8294718Medicare PIN
CA00A8294719Medicare PIN
CA00A829479Medicare PIN
CA00A829470Medicare PIN
CAP00298703Medicare PIN
CA00A8294714Medicare PIN
CA00A829478Medicare PIN
CA00A8294711Medicare PIN
CA00A829472Medicare PIN
CA00A829474Medicare PIN
CAP00133298Medicare PIN
CA00A8294716Medicare PIN
CA00A8294717Medicare PIN
CA00A829475Medicare PIN
CAP00184631Medicare PIN