Healthcare Provider Details

I. General information

NPI: 1255522637
Provider Name (Legal Business Name): GEORGE HC CHAN DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number1074
License Number StateHI

VIII. Authorized Official

Name: DR. GEORGE H. C. CHAN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 808-949-1607