Healthcare Provider Details

I. General information

NPI: 1912108564
Provider Name (Legal Business Name): SIU W. CHAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 NORIEGA ST SUITE 208
SAN FRANCISCO CA
94122-4259
US

IV. Provider business mailing address

2323 NORIEGA ST SUITE 208
SAN FRANCISCO CA
94122-4259
US

V. Phone/Fax

Practice location:
  • Phone: 415-759-7888
  • Fax: 415-759-7890
Mailing address:
  • Phone: 415-759-7888
  • Fax: 415-759-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: