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General NPI Number Information
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NPI Number | 1134781206
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Entity Type | Organization
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Legal Business Name | VISOTH CHAN, D.P.M., INC.
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 26732 CROWN VALLEY PKWY STE 317
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6374
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Country | US
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Telephone | 949-364-2525
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Fax | 949-364-3322
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Provider Business Mailing Address
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Address Line | 26732 CROWN VALLEY PKWY STE 317
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6374
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Country | US
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Telephone | 949-364-2525
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Fax | 949-364-3322
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Authorized Official
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Title or Position | HR
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Name | MIGUEL ANGEL CHUC
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Credential | MS
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Telephone | 949-364-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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