Basic Information
| Provider Information | |||||||||
| NPI: | 1346694536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | GARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 WESTWOOD PLZ STE 3304 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900958358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678653 | ||||||||
| FaxNumber: | 3102673766 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 WESTWOOD PLZ STE 3304 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900958358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102678653 | ||||||||
| FaxNumber: | 3102673766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | A166343 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.