Provider Demographics
NPI:1669558508
Name:CHAN, ANTONIO QUAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:QUAN
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:QUAN
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3726 LAS VEGAS BLVD S UNIT 3501W
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89158-4399
Mailing Address - Country:US
Mailing Address - Phone:702-882-6740
Mailing Address - Fax:
Practice Address - Street 1:1289 S. PARK VICTORIA DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6974
Practice Address - Country:US
Practice Address - Phone:408-586-8866
Practice Address - Fax:408-586-8858
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35593207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A355930Medicaid
CA00A355930Medicare PIN
CA00A355930Medicaid