Healthcare Provider Details

I. General information

NPI: 1386789402
Provider Name (Legal Business Name): CHUI CHAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST #2400
SAN FRANCISCO CA
94108-4206
US

IV. Provider business mailing address

450 SUTTER ST #2400
SAN FRANCISCO CA
94108-4206
US

V. Phone/Fax

Practice location:
  • Phone: 415-989-0552
  • Fax: 415-989-0554
Mailing address:
  • Phone: 415-989-0552
  • Fax: 415-989-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number40419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: