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General NPI Number Information
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NPI Number | 1376941468
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Entity Type | Organization
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Legal Business Name | STEVEN CHAN DDS DENTAL INC
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 2245 SANTA CLARA AVE STE#1
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City | ALAMEDA
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State | CA
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Zip | 94501-4429
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Country | US
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Telephone | 510-523-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 SANTA CLARA AVE STE#1
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City | ALAMEDA
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State | CA
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Zip | 94501-4429
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Country | US
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Telephone | 510-523-5121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN CHAN
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Credential | D.D.S
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Telephone | 510-523-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 57665
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License Number State | CA
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