Provider Demographics
NPI:1720452154
Name:CHAN UNITED MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHAN UNITED MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:626-308-0138
Mailing Address - Street 1:1001 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4772
Mailing Address - Country:US
Mailing Address - Phone:626-308-0138
Mailing Address - Fax:213-626-7868
Practice Address - Street 1:1001 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4772
Practice Address - Country:US
Practice Address - Phone:626-308-0138
Practice Address - Fax:213-626-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3832474208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA195JHG76Medicaid