Organization
SANNY K CHAN, MD, PHD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANNY K CHAN MD, PHD (CEO)
(720) 515-9810
Entity
Organization
Contact information
Practice address
1301 20TH ST STE 220, SANTA MONICA, CA 90404-2080
(310) 401-1434
(310) 453-8468
Mailing address
1301 20TH ST STE 220, SANTA MONICA, CA 90404-2080
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043449788
—
CA
05
—
333357366
—
CO
01
—
346419YLSH
MEDICARE PIN
CO
Enumeration date
05/17/2021
Last updated
05/17/2021
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