Provider Demographics
NPI:1417176009
Name:CHAN, DAVID K (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19120 SE 34TH ST
Mailing Address - Street 2:SUITE104
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1429
Mailing Address - Country:US
Mailing Address - Phone:360-885-1206
Mailing Address - Fax:
Practice Address - Street 1:19120 SE 34TH ST
Practice Address - Street 2:SUITE104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1429
Practice Address - Country:US
Practice Address - Phone:360-885-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist