Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | WA |
NPI | 1093882185 |
---|---|
Provider Name | Dr. Darlene Michelle Chan |
First Address | Seattle, WA 98116-4566 |
Second Address | Seattle, WA 98116-4566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5081005 | (05) | WA |
DE00005231 | LISCENSE (01) | WA |