Healthcare Provider Details

I. General information

NPI: 1790775310
Provider Name (Legal Business Name): LINH M CAO-CHAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SAN PABLO AVE
EL CERRITO CA
94530-3510
US

IV. Provider business mailing address

10110 SAN PABLO AVE
EL CERRITO CA
94530-3510
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-4747
  • Fax:
Mailing address:
  • Phone: 510-526-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: