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General NPI Number Information
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NPI Number | 1205661600
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Entity Type | Organization
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Legal Business Name | JUSTIN CHAN DDS
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 65-1230 MAMALAHOA HWY STE A21
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City | KAMUELA
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State | HI
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Zip | 96743-7317
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Country | US
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Telephone | 586-556-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 65-1230 MAMALAHOA HWY STE A21
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City | KAMUELA
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State | HI
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Zip | 96743-7317
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Country | US
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Telephone | 586-556-0220
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JUSTIN CHAN
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Credential | DDS
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Telephone | 586-556-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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