Provider Demographics
NPI:1104214469
Name:CHAN, EDWARD WAI-KIN (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WAI-KIN
Last Name:CHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S SOTO ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1303
Mailing Address - Country:US
Mailing Address - Phone:323-893-2307
Mailing Address - Fax:
Practice Address - Street 1:919 S SOTO ST STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1303
Practice Address - Country:US
Practice Address - Phone:323-264-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244509164W00000X
CA34021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No164W00000XNursing Service ProvidersLicensed Practical Nurse