# EDMOND L CHAN MD A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174824221
- **Authorized official:** VERONICA A RENTERIA (OFFICE MANAGER)
- **Authorized official phone:** (858) 485-5921

## Contact information

- **Practice address:** 15708 POMERADO RD \# N107, POWAY, CA 92064-2066
- **Practice address phone:** (858) 485-5921
- **Practice address fax:** (858) 485-1445
- **Mailing address:** 15708 POMERADO RD \# N107, POWAY, CA 92064-2066
- **Mailing address phone:** (858) 485-5921
- **Mailing address fax:** (858) 485-1445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A89731 | CA | Yes |

## Other

- **Enumeration date:** 11/05/2010
- **Last updated:** 05/04/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | EC809A | PTAN | CA |