Provider Demographics
NPI:1932427838
Name:DAVID CHAN MD INC
Entity Type:Organization
Organization Name:DAVID CHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-456-3844
Mailing Address - Street 1:4232 H ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3423
Mailing Address - Country:US
Mailing Address - Phone:916-456-3844
Mailing Address - Fax:916-456-2805
Practice Address - Street 1:4232 H ST
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3423
Practice Address - Country:US
Practice Address - Phone:916-456-3844
Practice Address - Fax:916-456-2805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID CHAN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-17
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22484207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A224840Medicaid
CA00A224840Medicaid
CA00A224840Medicare PIN