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General NPI Number Information
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NPI Number | 1245600014
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Entity Type | Organization
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Legal Business Name | LILLIAN CHAN, ND, LLC
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 3204 NE 25TH AVE
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City | PORTLAND
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State | OR
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Zip | 97212-2503
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Country | US
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Telephone | 503-705-3670
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Fax |
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Provider Business Mailing Address
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Address Line | 316 NE 19TH AVE
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City | PORTLAND
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State | OR
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Zip | 97232-2829
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Country | US
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Telephone | 503-778-0885
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Fax |
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Authorized Official
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Title or Position | NATUROPATHIC PHYSICIAN
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Name | DR. LILLIAN CHAN
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Credential | ND
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Telephone | 503-778-0885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 2032
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License Number State | OR
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