Provider Demographics
NPI:1205118304
Name:CHAN BAHEN, MINDY (PHARM D)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:CHAN BAHEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1001 W CARSON ST STE K
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 W CARSON ST STE K
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2051
Practice Address - Country:US
Practice Address - Phone:310-953-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist