Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 056876 | NY |
N | 213EG0000X | General Practice | 056876 | NY |
Y | 1223P0221X | Pediatric Dentist | DDS103801 | CA |
NPI | 1104185784 |
---|---|
Provider Name | Wai Chan |
First Address | Fresno, CA 93710-5270 |
Second Address | Fresno, CA 93710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 02/07/2019 |