Provider Demographics
NPI:1376941468
Name:STEVEN CHAN DDS DENTAL INC
Entity Type:Organization
Organization Name:STEVEN CHAN DDS DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-523-5121
Mailing Address - Street 1:2245 SANTA CLARA AVE
Mailing Address - Street 2:STE#1
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4429
Mailing Address - Country:US
Mailing Address - Phone:510-523-5121
Mailing Address - Fax:
Practice Address - Street 1:2245 SANTA CLARA AVE
Practice Address - Street 2:STE#1
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4429
Practice Address - Country:US
Practice Address - Phone:510-523-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty