Healthcare Provider Details

I. General information

NPI: 1952491656
Provider Name (Legal Business Name): CHAD LYEW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 ALEMANY BLVD 1002
SAN FRANCISCO CA
94132-3291
US

IV. Provider business mailing address

501 GROVE ST 4
SAN FRANCISCO CA
94102-4246
US

V. Phone/Fax

Practice location:
  • Phone: 650-997-3317
  • Fax: 650-756-3886
Mailing address:
  • Phone: 209-406-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: