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General NPI Number Information
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NPI Number | 1083527030
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Entity Type | Individual
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Provider Name | ETHAN CHHAN INTERN RPH
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Gender | Male
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 2295 S VINEYARD AVE
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City | ONTARIO
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State | CA
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Zip | 91761-7925
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Country | US
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Telephone | 866-536-1310
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Fax |
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Provider Business Mailing Address
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Address Line | 1876 W HAMPTON DR
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City | HANFORD
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State | CA
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Zip | 93230-9130
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Country | US
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Telephone | 559-589-3209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | INT50082
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License Number State | CA
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