Provider Demographics
NPI:1245963297
Name:CARNEY CHAN MD PC
Entity type:Organization
Organization Name:CARNEY CHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-210-2219
Mailing Address - Street 1:2220 LYNN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8017
Mailing Address - Country:US
Mailing Address - Phone:805-496-9727
Mailing Address - Fax:805-496-9148
Practice Address - Street 1:2220 LYNN RD STE 102
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8017
Practice Address - Country:US
Practice Address - Phone:805-496-9727
Practice Address - Fax:805-496-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty