Provider Demographics
NPI:1598922155
Name:KAN, SZE YAN
Entity Type:Individual
Prefix:MR
First Name:SZE YAN
Middle Name:
Last Name:KAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WILSON
Other - Middle Name:
Other - Last Name:KAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:212 9TH ST
Mailing Address - Street 2:STE 110
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4428
Mailing Address - Country:US
Mailing Address - Phone:510-839-7344
Mailing Address - Fax:
Practice Address - Street 1:212 9TH ST
Practice Address - Street 2:STE 110
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4428
Practice Address - Country:US
Practice Address - Phone:510-839-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6054156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician