Healthcare Provider Details

I. General information

NPI: 1508167883
Provider Name (Legal Business Name): WAI YEE CHAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 04/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COAST HWY
LAGUNA BEACH CA
92651-1513
US

IV. Provider business mailing address

600 N COAST HWY
LAGUNA BEACH CA
92651-1513
US

V. Phone/Fax

Practice location:
  • Phone: 949-376-3383
  • Fax: 949-376-4462
Mailing address:
  • Phone: 949-376-3383
  • Fax: 949-376-4462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: