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General NPI Number Information
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NPI Number | 1609922442
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Entity Type | Organization
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Legal Business Name | HEIDI L CHAN DDS INC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 9241 RESEDA BLVD SUITE 104
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-709-4400
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Fax | 818-709-4056
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Provider Business Mailing Address
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Address Line | 9241 RESEDA BLVD SUITE 104
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City | NORTHRIDGE
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State | CA
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Zip | 91324
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Country | US
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Telephone | 818-709-4400
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Fax | 818-709-4056
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HEIDI L CHAN
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Credential | DDS
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Telephone | 818-709-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46035
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License Number State | CA
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