Provider Demographics
NPI:1477638518
Name:CHAN, MICHAEL Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Y
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 1:2001 VAN NESS AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3040
Mailing Address - Country:US
Mailing Address - Phone:415-776-6710
Mailing Address - Fax:415-776-2850
Practice Address - Street 1:2001 VAN NESS AVE STE 401
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3040
Practice Address - Country:US
Practice Address - Phone:415-776-6710
Practice Address - Fax:415-776-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery