Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH073350 | PA |
NPI | 1053819664 |
---|---|
Provider Name | Manling Chan |
First Address | Philadelphia, PA 19146-3506 |
Second Address | Philadelphia, PA 19146-3506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2018 |
Last Update Date | 21/07/2021 |