Healthcare Provider Details

I. General information

NPI: 1104214469
Provider Name (Legal Business Name): EDWARD WAI-KIN CHAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 S SOTO ST STE 2
LOS ANGELES CA
90023-1303
US

IV. Provider business mailing address

919 S SOTO ST STE 2
LOS ANGELES CA
90023-1303
US

V. Phone/Fax

Practice location:
  • Phone: 323-264-7878
  • Fax:
Mailing address:
  • Phone: 323-893-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number244509
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: