MEDICARE: CHAN W HAN DMD PS

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	122300000X	Dentist

General Provider Information

NPI Number	:	1043168321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAN W HAN DMD PS

Provider Business Mailing Address
First Line	:	14957 N KELSEY ST STE 106
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-1427
Country	:	US
Telephone Number	:	360-863-8070
Fax Number	:

Provider Business Practice Location Address
First Line	:	14957 N KELSEY ST STE 106
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-1427
Country	:	US
Telephone Number	:	360-863-8070
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHAN W HAN
Credential	:	DMD
Telephone Number	:	360-863-8070

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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