Provider Demographics
NPI:1578002044
Name:CHAN, ANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:DAVYDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3601 W. HIDDEN LN
Mailing Address - Street 2:UNIT 215
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:917-374-5031
Mailing Address - Fax:
Practice Address - Street 1:23332 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3749
Practice Address - Country:US
Practice Address - Phone:310-791-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist