Provider Demographics
NPI:1790851681
Name:CHAN, EVA YEE WAH (LAC)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:YEE WAH
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:1011 NORTH COLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038
Mailing Address - Country:US
Mailing Address - Phone:323-469-8062
Mailing Address - Fax:323-469-8064
Practice Address - Street 1:1011 NORTH COLE AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038
Practice Address - Country:US
Practice Address - Phone:323-469-8062
Practice Address - Fax:323-469-8064
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5648171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist