Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 2065 | HI |
NPI | 1962614768 |
---|---|
Provider Name | Denis T.c. Chan |
First Address | Waipahu, HI 96797-3350 |
Second Address | Waipahu, HI 96797-3350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0003437-1 | HMSA,Q,HMA,UHA (01) | HI |
030931-01 | (05) | HI |
99-0187502 | (02) | HI |