MEDICARE: ANDREW CHAN & LINDA CHAN, DDS, 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	122300000X	Dentist	47354	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1111	OTHER	CA	DENTIST

General Provider Information

NPI Number	:	1881012466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW CHAN & LINDA CHAN, DDS, INC.

Provider Business Mailing Address
First Line	:	9750 MIRAMAR RD STE 320
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9750 MIRAMAR RD STE 320
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4563
Country	:	US
Telephone Number	:	858-527-0365
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LINDA H. CHAN
Credential	:	DDS
Telephone Number	:	858-527-0365

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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