Provider Demographics
NPI:1346383007
Name:CHAN, MELINDA JEAN (DDS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:JEAN
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5277 COLLEGE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1437
Mailing Address - Country:US
Mailing Address - Phone:510-654-2226
Mailing Address - Fax:
Practice Address - Street 1:5277 COLLEGE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1437
Practice Address - Country:US
Practice Address - Phone:510-654-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice