Healthcare Provider Details

I. General information

NPI: 1841293578
Provider Name (Legal Business Name): RAYMOND MAN-SHU CHAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

500 S ANAHEIM HILLS RD STE 228
ANAHEIM CA
92807-5213
US

IV. Provider business mailing address

PO BOX 18522
ANAHEIM CA
92817-8522
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-7800
  • Fax:
Mailing address:
  • Phone: 714-282-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: