MEDICARE: MAN CHAU D.M.D. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4873	NV

General Provider Information

NPI Number	:	1023234101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAN CHAU D.M.D. PC

Provider Business Mailing Address
First Line	:	4359 MILFORD POND PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6103
Country	:	US
Telephone Number	:	702-979-8474
Fax Number	:

Provider Business Practice Location Address
First Line	:	6430 W LAKE MEAD BLVD
Second Line	:	#140
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-7307
Country	:	US
Telephone Number	:	702-647-3377
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAN VAN CHAU
Credential	:	D.M.D.
Telephone Number	:	702-979-8474

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/03/2008

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