Individual
JEFFERSON Y CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
101 THE CITY DR S, ORANGE, CA 92868-3201
(714) 456-6141
(714) 456-5873
Mailing address
PO BOX 513377, LOS ANGELES, CA 90051-3377
(714) 456-8835
(714) 456-6248
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
G84497
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G844970
BLUE SHIELD
CA
05
—
00G844970
—
CA
01
—
WG84497A
MEDICARE PTAN
CA
Enumeration date
04/26/2007
Last updated
03/25/2008
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