Provider Demographics
NPI:1083789093
Name:CHAN, DENNIS KEN (DSS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KEN
Last Name:CHAN
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 E IMPERIAL HWY
Mailing Address - Street 2:SUITE E-11
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5606
Mailing Address - Country:US
Mailing Address - Phone:714-990-9210
Mailing Address - Fax:714-990-5051
Practice Address - Street 1:1033 E IMPERIAL HWY
Practice Address - Street 2:SUITE E-11
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5606
Practice Address - Country:US
Practice Address - Phone:714-990-9210
Practice Address - Fax:714-990-5051
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice