Provider Demographics
NPI:1295033520
Name:CHAN, SOPHIA SHIN CHUNG
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:SHIN CHUNG
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2549
Mailing Address - Country:US
Mailing Address - Phone:626-471-6532
Mailing Address - Fax:626-471-3572
Practice Address - Street 1:301 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2549
Practice Address - Country:US
Practice Address - Phone:626-471-6500
Practice Address - Fax:626-471-3572
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker