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General NPI Number Information
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NPI Number | 1568749729
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Entity Type | Organization
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Legal Business Name | BRIAN H CHAN, DDS, INC.
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 16766 BERNARDO CENTER DR STE 100A
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City | SAN DIEGO
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State | CA
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Zip | 92128-2501
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Country | US
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Telephone | 858-485-6781
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Fax |
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Provider Business Mailing Address
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Address Line | 16766 BERNARDO CENTER DR STE 100A
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City | SAN DIEGO
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State | CA
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Zip | 92128-2501
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Country | US
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Telephone | 858-485-6781
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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. BRIAN H CHAN
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Credential | DDS
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Telephone | 858-485-6781
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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 | 55839
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License Number State | CA
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