Edmond L Chan MD a Medical Corporation

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

A89731 Issued in CA

Legal business name

EDMOND L CHAN MD A MEDICAL CORPORATION

Practice address

15708 Pomerado Rd # N107
Poway, CA 92064-2066

Phone

(858) 485-5921

Fax

(858) 485-1445

NPI assigned

Nov 5, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Veronica A Renteria

Title

Office Manager

Phone

(858) 485-5921

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1174824221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15708 POMERADO RD # N107",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642066",
            "telephone_number": "858-485-5921",
            "fax_number": "858-485-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15708 POMERADO RD # N107",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642066",
            "telephone_number": "858-485-5921",
            "fax_number": "858-485-1445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDMOND L CHAN MD A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-05",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "RENTERIA",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "858-485-5921"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A89731",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "EC809A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Poway, CA
• Providers in Poway, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.