Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10737 | NV |
NPI | 1003848177 |
---|---|
Provider Name | David Tit-Chiu Chan |
First Address | Henderson, NV 89052-7087 |
Second Address | Henderson, NV 89015-5534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 03/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100502315 | (05) | NV |
A40583 | (02) | NV |