Healthcare Provider Details

I. General information

NPI: 1881977502
Provider Name (Legal Business Name): DOYLENE CHAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE SUITE 202
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

105 N BASCOM AVE SUITE 202
SAN JOSE CA
95128-1811
US

V. Phone/Fax

Practice location:
  • Phone: 408-475-1011
  • Fax:
Mailing address:
  • Phone: 408-475-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number23344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: