Provider Demographics
NPI:1740456847
Name:JOHOL C CHAN DO PA
Entity type:Organization
Organization Name:JOHOL C CHAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHOL
Authorized Official - Middle Name:CHO-HONG
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:956-795-8236
Mailing Address - Street 1:PO BOX 450193
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0004
Mailing Address - Country:US
Mailing Address - Phone:956-795-8236
Mailing Address - Fax:956-718-6994
Practice Address - Street 1:7210 MCPHERSON RD STE 120
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6505
Practice Address - Country:US
Practice Address - Phone:956-795-8236
Practice Address - Fax:956-718-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159242001Medicaid
TXD05769OtherPALMETTO GBA (MEDICARE RAILROAD)
TXD05769OtherPALMETTO GBA (MEDICARE RAILROAD)