Organization
SAMUEL C. CHAN, D.O., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL C. CHAN D.O. (PRESIDENT)
(214) 330-3034
Entity
Organization
Contact information
Practice address
5787 S HAMPTON RD, SUITE 300, LB 134, DALLAS, TX 75232-2255
(214) 330-3034
(214) 330-3096
Mailing address
5787 S HAMPTON RD, SUITE 300, LB 134, DALLAS, TX 75232-2255
(214) 330-3034
(214) 330-3096
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00128N
MEDICARE PTAN
TX
05
—
079946202
—
TX
01
—
5900480001
PTAN
TX
Enumeration date
04/05/2006
Last updated
05/12/2011
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