MEDICARE: DR. WAI MING CHAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	28290	CA

General Provider Information

NPI Number	:	1407856883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAI MING CHAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 293055
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95829-3055
Country	:	US
Telephone Number	:	916-267-4816
Fax Number	:

Provider Business Practice Location Address
First Line	:	7223 S LAND PARK DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3611
Country	:	US
Telephone Number	:	916-267-4816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	11/15/2012

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