Healthcare Provider Details

I. General information

NPI: 1346431723
Provider Name (Legal Business Name): GEORGE H. C. CHAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 720
HONOLULU HI
96814-4404
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 720
HONOLULU HI
96814-4404
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-1607
  • Fax: 808-947-5007
Mailing address:
  • Phone: 808-949-1607
  • Fax: 808-947-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1074
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: