Provider Demographics
NPI:1902094550
Name:ONN T. CHAN M.D., INC.
Entity Type:Organization
Organization Name:ONN T. CHAN M.D., INC.
Other - Org Name:ONN T. CHAN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ONN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-335-0588
Mailing Address - Street 1:1135 E ROUTE 66 STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3769
Mailing Address - Country:US
Mailing Address - Phone:626-335-0588
Mailing Address - Fax:626-852-1526
Practice Address - Street 1:1135 E ROUTE 66 STE 106
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3769
Practice Address - Country:US
Practice Address - Phone:626-335-0588
Practice Address - Fax:626-852-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A164110Medicaid
CAW17351Medicare PIN