Provider Demographics
NPI:1336307214
Name:CHAN, JANE H (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:H
Last Name:CHAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:H
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:19427 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7147
Mailing Address - Country:US
Mailing Address - Phone:562-402-6187
Mailing Address - Fax:
Practice Address - Street 1:19427 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7147
Practice Address - Country:US
Practice Address - Phone:562-402-6187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist