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General NPI Number Information
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NPI Number | 1982220497
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Entity Type | Individual
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Provider Name | JUSTIN CHAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/20/2020
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 65-1230 MAMALAHOA HWY STE A21
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City | KAMUELA
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State | HI
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Zip | 96743-7317
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Country | US
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Telephone | 808-885-8465
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Fax |
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Provider Business Mailing Address
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Address Line | 65-1230 MAMALAHOA HWY STE A21
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City | KAMUELA
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State | HI
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Zip | 96743-7317
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Country | US
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Telephone | 586-556-0220
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600517
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT-3140
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License Number State | HI
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