Healthcare Provider Details

I. General information

NPI: 1699765701
Provider Name (Legal Business Name): MICHELE CHAN DEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD SUITE 8211
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

3530 WILSHIRE BLVD SUITE 350
LOS ANGELES CA
90010-2328
US

V. Phone/Fax

Practice location:
  • Phone: 213-637-3703
  • Fax: 213-427-3659
Mailing address:
  • Phone: 213-637-3703
  • Fax: 213-427-3659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA60317
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA60317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: