=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023234101
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAN CHAU D.M.D. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 09/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6430 W LAKE MEAD BLVD #140
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89108-7307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-647-3377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4359 MILFORD POND PL
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-6103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-979-8474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAN VAN CHAU
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 702-979-8474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4873
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------