MEDICARE: EUGENIA CHAN D.D.S.

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	1223P0700X	Prosthodontics	DN1857307	MA
2	1223P0700X	Prosthodontics	100952	CA

General Provider Information

NPI Number	:	1790137313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA CHAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 1754
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91754-8754
Country	:	US
Telephone Number	:	626-226-9351
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 EL DORADO ST STE 200
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2506
Country	:	US
Telephone Number	:	626-793-6700
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	09/22/2020

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Directions to “ EUGENIA CHAN D.D.S.” Practice Location

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