Provider Demographics
NPI:1588602338
Name:CHAN, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ASSEMBLY CT
Mailing Address - Street 2:#C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2608
Mailing Address - Country:US
Mailing Address - Phone:916-421-1772
Mailing Address - Fax:916-421-0635
Practice Address - Street 1:5525 ASSEMBLY CT
Practice Address - Street 2:#C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2608
Practice Address - Country:US
Practice Address - Phone:916-421-1772
Practice Address - Fax:916-421-0635
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20775207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A22325Medicare ID - Type Unspecified
CAA22325Medicare UPIN