Provider Demographics
NPI:1548649254
Name:CHAN, GARY CHI-HUNG (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHI-HUNG
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 REINHARDT COLLEGE PKWY STE 110A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 REINHARDT COLLEGE PKWY STE 110A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5257
Practice Address - Country:US
Practice Address - Phone:770-720-2383
Practice Address - Fax:833-605-3236
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA99861207R00000X, 207RC0000X
IADO-05713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine