Healthcare Provider Details

I. General information

NPI: 1083527030
Provider Name (Legal Business Name): ETHAN CHHAN INTERN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S VINEYARD AVE
ONTARIO CA
91761-7925
US

IV. Provider business mailing address

1876 W HAMPTON DR
HANFORD CA
93230-9130
US

V. Phone/Fax

Practice location:
  • Phone: 866-536-1310
  • Fax:
Mailing address:
  • Phone: 559-589-3209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberINT50082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: