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Individual

BRYAN EDWIN CHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1225 WILSHIRE BLVD, LOS ANGELES, CA 90017-1901
(213) 977-2180
Mailing address
28128 PEACOCK RIDGE DR APT 103, RANCHO PALOS VERDES, CA 90275-3444
(310) 750-6397

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A54240
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A542400
BLUE SHIELD
CA
05
00A542400
CA
Enumeration date
05/18/2006
Last updated
03/20/2013
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