Provider Demographics
NPI:1467795245
Name:CHAN, SELENA (DO)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 DIVISADERO ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3400
Mailing Address - Country:US
Mailing Address - Phone:415-353-7700
Mailing Address - Fax:
Practice Address - Street 1:1545 DIVISADERO ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-3400
Practice Address - Country:US
Practice Address - Phone:415-353-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A152762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A15276OtherOSTEOPATHIC CALIFORNIA MEDICAL LICENSE
CA20A15276OtherOSTEOPATHIC CALIFORNIA MEDICAL LICENSE