Provider Demographics
NPI:1356300982
Name:CHAN, TILUN JOSEPHINE (DDS)
Entity Type:Individual
Prefix:
First Name:TILUN
Middle Name:JOSEPHINE
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 1:300 GRAND AVENUE P2S
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-569-5003
Mailing Address - Fax:201-569-5005
Practice Address - Street 1:300 GRAND AVENUE P2S
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-569-5003
Practice Address - Fax:201-569-5005
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice