Organization Name: | SAMUEL CHAN MEDICAL,PC |
NPI Number: | 1700172814 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD JAY LOTTO (PRESIDENT) |
Mailing Address: | 3530 Atlantic Ave Suite 101 Long Beach |
State: | CA US |
Postal Code: | 908074569 |
Phone Number: | 5625958728 |
Fax Number: | 5624907395 |
NPI Enumeration Date: | 06/27/2011 |
NPI Last Update Date: | 06/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G26972 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |