Provider Demographics
NPI:1043095078
Name:CHANN, SAM (NP)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:CHANN
Suffix:
Gender:M
Credentials:NP
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 40193
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6193
Mailing Address - Country:US
Mailing Address - Phone:562-726-2382
Mailing Address - Fax:
Practice Address - Street 1:5001 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5441
Practice Address - Country:US
Practice Address - Phone:877-782-0300
Practice Address - Fax:424-455-2274
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily