Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | NP9382 | CA |
NPI | 1033279344 |
---|---|
Provider Name | Ms. Lilian Yuet Chun Chan |
First Address | Fremont, CA 94538-2310 |
Second Address | Fremont, CA 94538-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P18908 | (02) |