Provider Demographics
NPI:1497303093
Name:CHAN, RITA KA YAN
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KA YAN
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11427 ELMCREST ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1806
Mailing Address - Country:US
Mailing Address - Phone:626-267-7828
Mailing Address - Fax:
Practice Address - Street 1:11427 ELMCREST ST
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-1806
Practice Address - Country:US
Practice Address - Phone:626-267-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program