Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | NP12250 | CA |
NPI | 1093826620 |
---|---|
Provider Name | Judy H. Chan |
First Address | Santa Ana, CA 92705-8505 |
Second Address | Santa Ana, CA 92705-8505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 10/06/2021 |