Provider Demographics
NPI:1235348251
Name:CHAN, DAVID MATHIAS (L AC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATHIAS
Last Name:CHAN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14091 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4666
Mailing Address - Country:US
Mailing Address - Phone:714-373-2205
Mailing Address - Fax:714-373-0725
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 225A
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-379-5215
Practice Address - Fax:714-379-5216
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC2464171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist