MEDICARE: CURTIS L. CHAN D.D.S., INC.

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	DB034823	CA

General Provider Information

NPI Number	:	1558492918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CURTIS L. CHAN D.D.S., INC.

Provider Business Mailing Address
First Line	:	12750 CARMEL COUNTRY RD
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2159
Country	:	US
Telephone Number	:	858-481-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	12750 CARMEL COUNTRY RD
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2159
Country	:	US
Telephone Number	:	858-481-9090
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CURTIS LELAND CHAN
Credential	:	D.D.S.
Telephone Number	:	858-481-9090

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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