Healthcare Provider Details

I. General information

NPI: 1205926052
Provider Name (Legal Business Name): DANIEL ENRIQUE CHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 MISSION ST #329
SAN FRANCISCO CA
94110-2487
US

IV. Provider business mailing address

2480 MISSION ST #329
SAN FRANCISCO CA
94110-2487
US

V. Phone/Fax

Practice location:
  • Phone: 415-826-2438
  • Fax: 415-826-2702
Mailing address:
  • Phone: 415-826-2438
  • Fax: 415-826-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberPA17553
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: