Healthcare Provider Details

I. General information

NPI: 1932391471
Provider Name (Legal Business Name): WAN-YIN CHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W LA VETA AVE STE 100
ORANGE CA
92868-4445
US

IV. Provider business mailing address

725 W LA VETA AVE STE 100
ORANGE CA
92868-4445
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-6363
  • Fax:
Mailing address:
  • Phone: 714-633-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA101604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: