Healthcare Provider Details

I. General information

NPI: 1295252674
Provider Name (Legal Business Name): CHRISTINE CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HOWARD STREET 3 FLOOR
SAN FRANCISCO CA
94103
US

IV. Provider business mailing address

1380 HOWARD ST FL 3
SAN FRANCISCO CA
94103-2650
US

V. Phone/Fax

Practice location:
  • Phone: 415-255-3547
  • Fax: 415-252-3035
Mailing address:
  • Phone: 415-255-3547
  • Fax: 415-252-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: