Healthcare Provider Details

I. General information

NPI: 1831753839
Provider Name (Legal Business Name): DANIEL YUE-KING CHAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S CATARACT AVE
SAN DIMAS CA
91773-2902
US

IV. Provider business mailing address

430 S CATARACT AVE
SAN DIMAS CA
91773-2902
US

V. Phone/Fax

Practice location:
  • Phone: 424-645-7575
  • Fax: 424-644-2575
Mailing address:
  • Phone: 424-645-7575
  • Fax: 424-644-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDRH065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: