Individual
DR. JESSICA LORETTA CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8635 W 3RD ST, SUITE 160 WEST, LOS ANGELES, CA 90048-6101
(310) 423-5798
Mailing address
8635 W 3RD ST, SUITE 160 WEST, LOS ANGELES, CA 90048-6101
(310) 423-5798
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
A115642
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RES000
—
CA
Enumeration date
11/21/2009
Last updated
11/17/2016
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