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General NPI Number Information
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NPI Number | 1124283676
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Entity Type | Individual
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Provider Name | DEREK MK CHAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 426 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75217-6521
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Country | US
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Telephone | 469-248-2958
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Fax |
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Provider Business Mailing Address
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Address Line | 2257 GULFSTREAM DR
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City | LITTLE ELM
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State | TX
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Zip | 75068-5978
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Country | US
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Telephone | 214-771-8882
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30022764
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25315
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License Number State | TX
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