Healthcare Provider Details

I. General information

NPI: 1669393831
Provider Name (Legal Business Name): JOANNA CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E MAIN ST
ELMA WA
98541-9560
US

IV. Provider business mailing address

817 N 3RD ST
ELMA WA
98541-9562
US

V. Phone/Fax

Practice location:
  • Phone: 613-863-9907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMDRE.ML.70124151
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: