Provider Demographics
NPI:1093882185
Name:CHAN, DARLENE MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:MICHELLE
Last Name:CHAN
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 1:4744 41ST AVE SW SUITE 107
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4566
Mailing Address - Country:US
Mailing Address - Phone:206-932-8572
Mailing Address - Fax:206-932-2272
Practice Address - Street 1:4744 41ST AVE SW SUITE 107
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4566
Practice Address - Country:US
Practice Address - Phone:206-932-8572
Practice Address - Fax:206-932-2272
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00005231OtherLISCENSE
WA5081005Medicaid
WADE00005231OtherLISCENSE