Provider Demographics
NPI:1740768852
Name:YOS, CHAN SARICK
Entity Type:Individual
Prefix:
First Name:CHAN
Middle Name:SARICK
Last Name:YOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5522
Mailing Address - Country:US
Mailing Address - Phone:209-464-5519
Mailing Address - Fax:
Practice Address - Street 1:405 E PINE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5522
Practice Address - Country:US
Practice Address - Phone:209-464-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician