Provider Demographics
NPI:1245530104
Name:TAI, CHUN YAN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:CHUN
Middle Name:YAN
Last Name:TAI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:TAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2505 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1603
Mailing Address - Country:US
Mailing Address - Phone:925-831-9502
Mailing Address - Fax:925-831-2547
Practice Address - Street 1:2505 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1603
Practice Address - Country:US
Practice Address - Phone:925-831-9502
Practice Address - Fax:925-831-2547
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist