Healthcare Provider Details

I. General information

NPI: 1871509026
Provider Name (Legal Business Name): VIVIEN CHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/24/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 STUDENT HEALTH
IRVINE CA
92697
US

IV. Provider business mailing address

1 QUAIL BUSH
IRVINE CA
92618-4055
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-5304
  • Fax: 949-824-0323
Mailing address:
  • Phone: 949-274-8809
  • Fax: 949-824-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA70354
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA70354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: