Provider Demographics
NPI:1538255617
Name:CHAN, JOEL ANTEOL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ANTEOL
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 LAKEFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2673
Mailing Address - Country:US
Mailing Address - Phone:805-496-3838
Mailing Address - Fax:805-496-7418
Practice Address - Street 1:756 LAKEFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2673
Practice Address - Country:US
Practice Address - Phone:805-496-3838
Practice Address - Fax:419-866-8453
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62548207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A625480Medicaid
CA00A625480Medicaid