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General NPI Number Information
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NPI Number | 1225615743
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Entity Type | Individual
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Provider Name | RICHARD CHAN CAA
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1 WYOMING ST STE 3027A
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City | DAYTON
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State | OH
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Zip | 45409-2722
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Country | US
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Telephone | 937-208-6173
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 N LOOP 1604 E # 105-446
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1339
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Country | US
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Telephone | 210-598-2800
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 67.000530
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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