Provider Demographics
NPI:1043233117
Name:LAN, CHIAHSIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHIAHSIN
Middle Name:
Last Name:LAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 TOWN CENTER LN STE 190
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3230
Mailing Address - Country:US
Mailing Address - Phone:408-873-8321
Mailing Address - Fax:408-873-8320
Practice Address - Street 1:20410 TOWN CENTER LN STE 190
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3230
Practice Address - Country:US
Practice Address - Phone:408-873-8321
Practice Address - Fax:408-873-8320
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice