Provider Demographics
NPI:1770578874
Name:CHAN, SECK LAM (MD)
Entity type:Individual
Prefix:DR
First Name:SECK
Middle Name:LAM
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:728 PACIFIC AVENUE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4449
Mailing Address - Country:US
Mailing Address - Phone:415-202-0260
Mailing Address - Fax:415-202-0265
Practice Address - Street 1:728 PACIFIC AVENUE
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4449
Practice Address - Country:US
Practice Address - Phone:415-202-0260
Practice Address - Fax:415-202-0265
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC43212208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C432120Medicaid
CA1458527OtherMEDI-CAL PIN
CAC43212OtherSTATE LICENSE
CACH015ZOtherMEDCIARE PTAN
CA1458527OtherMEDI-CAL PIN