Provider Demographics
NPI:1841395043
Name:CHAN, GENY-ANA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENY-ANA
Middle Name:R
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3218
Mailing Address - Country:US
Mailing Address - Phone:559-445-9840
Mailing Address - Fax:559-445-9628
Practice Address - Street 1:1223 FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3218
Practice Address - Country:US
Practice Address - Phone:559-445-9840
Practice Address - Fax:559-445-9628
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice