Provider Demographics
NPI:1184643876
Name:CHAN, CLIFFORD RAY (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:RAY
Last Name:CHAN
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E FLORIDA AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8638
Mailing Address - Country:US
Mailing Address - Phone:951-766-4354
Mailing Address - Fax:951-766-4356
Practice Address - Street 1:1600 E FLORIDA AVE STE 207
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8638
Practice Address - Country:US
Practice Address - Phone:951-766-4354
Practice Address - Fax:951-766-4356
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics