Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A120315 | CA |
NPI | 1033372768 |
---|---|
Provider Name | Dr. Chung-Yin Stanley Chan |
First Address | Elk Grove, CA 95758 |
Second Address | Elk Grove, CA 95758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 17/01/2022 |