Provider Demographics
NPI:1447486188
Name:CHAN, ESTRELLITA LUA (MD)
Entity type:Individual
Prefix:DR
First Name:ESTRELLITA
Middle Name:LUA
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ESTRELLITA
Other - Middle Name:LUA
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1289 S PARK VICTORIA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6996
Mailing Address - Country:US
Mailing Address - Phone:408-586-8866
Mailing Address - Fax:408-586-8858
Practice Address - Street 1:1289 S PARK VICTORIA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6996
Practice Address - Country:US
Practice Address - Phone:408-586-8866
Practice Address - Fax:408-586-8858
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35751207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35751OtherMEDICAL BOARD