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NPI Code Detail

MEDICARE: KRISTY CHAN

MEDICARE: KRISTY CHAN
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
1224Z00000XOccupational Therapy Assistant3524CA

General Provider Information

NPI Number : 1922580216
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY CHAN
Provider Business Mailing Address
First Line : 9317 MAPLEVIEW WAY
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-5010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 442 E HAMPTON ST
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5519
Country : US
Telephone Number : 209-466-0456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2018
Last Update Date : 09/03/2018

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Directions to “ KRISTY CHAN ” Practice Location

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