MEDICARE: DR. DARLENE MICHELLE CHAN DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE00005231	OTHER	WA	LISCENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093882185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARLENE MICHELLE CHAN DDS

Provider Business Mailing Address
First Line	:	4744 41ST AVE SW SUITE 107
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4566
Country	:	US
Telephone Number	:	206-932-8572
Fax Number	:	206-932-2272

Provider Business Practice Location Address
First Line	:	4744 41ST AVE SW SUITE 107
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4566
Country	:	US
Telephone Number	:	206-932-8572
Fax Number	:	206-932-2272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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