Provider Demographics
NPI:1376695460
Name:CHAN, WESLEY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 S WHITE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4045
Mailing Address - Country:US
Mailing Address - Phone:408-238-6474
Mailing Address - Fax:408-238-6486
Practice Address - Street 1:3151 S WHITE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4045
Practice Address - Country:US
Practice Address - Phone:408-238-6474
Practice Address - Fax:408-238-6486
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice