Provider Demographics
NPI:1417079468
Name:CHAN, WILLIAM WAI-LEONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAI-LEONG
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 1:1659 N BEVERLY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2707
Mailing Address - Country:US
Mailing Address - Phone:310-497-2578
Mailing Address - Fax:
Practice Address - Street 1:2511 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3209
Practice Address - Country:US
Practice Address - Phone:310-542-6988
Practice Address - Fax:310-542-3182
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice