Provider Demographics
NPI:1053343434
Name:CHAN, DENNIS Y (M D)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:Y
Last Name:CHAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6427
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-6427
Mailing Address - Country:US
Mailing Address - Phone:626-280-3225
Mailing Address - Fax:626-280-4222
Practice Address - Street 1:500 N GARFIELD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1242
Practice Address - Country:US
Practice Address - Phone:626-280-3225
Practice Address - Fax:626-280-4222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43296207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A432961Medicaid
00A432960OtherBLUE SHIELD
CAE89842Medicare UPIN
CAA43296Medicare PIN