Healthcare Provider Details

I. General information

NPI: 1285356279
Provider Name (Legal Business Name): CHAN DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 LOUETTA RD # 100
SPRING TX
77379-6737
US

IV. Provider business mailing address

8403 LOUETTA RD # 100
SPRING TX
77379-6737
US

V. Phone/Fax

Practice location:
  • Phone: 832-835-1974
  • Fax: 832-552-1567
Mailing address:
  • Phone: 832-279-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN RICHARD CHAN
Title or Position: DIRECTOR
Credential: D.O.
Phone: 832-835-1974