Provider Demographics
NPI:1497991566
Name:CHAN, SHUN-CHIEH JACK (MSN, NP)
Entity Type:Individual
Prefix:MR
First Name:SHUN-CHIEH
Middle Name:JACK
Last Name:CHAN
Suffix:
Gender:M
Credentials:MSN, NP
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, NP
Mailing Address - Street 1:1940 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1409
Mailing Address - Country:US
Mailing Address - Phone:415-476-6041
Mailing Address - Fax:415-476-4700
Practice Address - Street 1:1940 BRYANT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1409
Practice Address - Country:US
Practice Address - Phone:415-476-6041
Practice Address - Fax:415-476-4700
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577720163W00000X
CA63642163WH0200X
CA15505363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health