Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 0442000431 | VA |
NPI | 1003484502 |
---|---|
Provider Name | Victor Chan |
First Address | Gainesville, FL 32608-1015 |
Second Address | Richmond, VA 23298-5064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |