Healthcare Provider Details

I. General information

NPI: 1265536726
Provider Name (Legal Business Name): ANGELINE Y CHAN D.D.S, CAGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELINE Y CHAN-KOSIE DDS, CAGS

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 CHURCH ST SUITE 520
NASHVILLE TN
37219-2428
US

IV. Provider business mailing address

18 DAY ST APT 312
SOMERVILLE MA
02144-2806
US

V. Phone/Fax

Practice location:
  • Phone: 615-750-0323
  • Fax:
Mailing address:
  • Phone: 920-217-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6039
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21406
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: