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General NPI Number Information
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NPI Number | 1639547490
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Entity Type | Individual
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Provider Name | TINA L CHAN AU.D.
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Gender | Female
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 19520 NORDHOFF ST STE 5
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2451
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Country | US
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Telephone | 818-734-9124
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Fax |
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Provider Business Mailing Address
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Address Line | 5882 BOLSA AVE SUITE 130
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-5702
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Country | US
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Telephone | 714-898-5732
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Fax | 714-901-4058
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 3067
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License Number State | CA
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