Provider Demographics
NPI:1366468332
Name:CHAN, DANIEL S (PHD, FICPP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHD, FICPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11107 MCVINE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2121
Mailing Address - Country:US
Mailing Address - Phone:818-229-6121
Mailing Address - Fax:818-352-6262
Practice Address - Street 1:3733 ROSEMEAD BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1981
Practice Address - Country:US
Practice Address - Phone:818-229-6121
Practice Address - Fax:818-352-6262
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY111400Medicaid
CAPSY111400Medicaid