Provider Demographics
NPI:1295807089
Name:CHANN & CHANN MD PROFESSIONAL CORP
Entity type:Organization
Organization Name:CHANN & CHANN MD PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHANN & CHANN MD PC
Authorized Official - Prefix:
Authorized Official - First Name:HARCHARN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-449-9100
Mailing Address - Street 1:6089 N 1ST
Mailing Address - Street 2:ST 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-449-9100
Mailing Address - Fax:559-449-9440
Practice Address - Street 1:6089 N 1ST
Practice Address - Street 2:ST 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-449-9100
Practice Address - Fax:559-449-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49816YMedicare PIN