Organization
CHAN MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAN HOR CHAN M.D. (PRESIDENT)
(209) 826-4771
Entity
Organization
Contact information
Practice address
600 W I ST, SUITE C, LOS BANOS, CA 93635-3460
(209) 826-4771
(209) 826-8565
Mailing address
600 W I ST, SUITE C, LOS BANOS, CA 93635-3460
(209) 826-4771
(209) 826-8565
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A257340
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ76229Z
—
CA
Enumeration date
11/06/2006
Last updated
06/21/2018
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