Provider Demographics
NPI:1396441929
Name:MAI-SIE CHAN, M.D., INC
Entity type:Organization
Organization Name:MAI-SIE CHAN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAI-SIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-956-6633
Mailing Address - Street 1:929 CLAY ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1570
Mailing Address - Country:US
Mailing Address - Phone:415-956-6633
Mailing Address - Fax:415-956-6638
Practice Address - Street 1:929 CLAY ST STE 303
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1570
Practice Address - Country:US
Practice Address - Phone:415-956-6633
Practice Address - Fax:415-956-6638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A833620Medicaid