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General NPI Number Information
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NPI Number | 1801094032
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Entity Type | Individual
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Provider Name | JACQUELINE W.L. CHAN M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 447 W EATON AVE
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City | TRACY
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State | CA
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Zip | 95376-3420
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Country | US
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Telephone | 209-830-4063
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Fax |
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Provider Business Mailing Address
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Address Line | 600 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-4201
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Country | US
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Telephone | 209-524-1211
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Fax |
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A92182
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License Number State | CA
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