Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10364990-1205 | UT |
N | 207Q00000X | Family Doctor | 13484 | FL |
N | 207Q00000X | Family Doctor | A121675 | CA |
N | 207Q00000X | Family Doctor | ME108391 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | XC3767704 | UT |
NPI | 1902031545 |
---|---|
Provider Name | Melissa M. Chan |
First Address | Slc, UT 84109-2728 |
Second Address | Slc, UT 84109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 21/03/2019 |