Provider Demographics
NPI:1235605957
Name:LUC, CHAN T (FNP)
Entity type:Individual
Prefix:
First Name:CHAN
Middle Name:T
Last Name:LUC
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N DOS ROBLES PL
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1216
Mailing Address - Country:US
Mailing Address - Phone:626-863-3971
Mailing Address - Fax:
Practice Address - Street 1:6501 GARFIELD AVE # A
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1805
Practice Address - Country:US
Practice Address - Phone:562-775-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily