Provider Demographics
NPI:1871509026
Name:CHAN, VIVIEN (MD)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 QUAIL BUSH
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4055
Mailing Address - Country:US
Mailing Address - Phone:949-274-8809
Mailing Address - Fax:949-824-0323
Practice Address - Street 1:501 STUDENT HEALTH
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697
Practice Address - Country:US
Practice Address - Phone:949-824-5304
Practice Address - Fax:949-824-0323
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA703542084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry