Provider Demographics
NPI:1356607451
Name:CHAN, AEGEAN H (MD)
Entity type:Individual
Prefix:
First Name:AEGEAN
Middle Name:H
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 1:2323 OAK PARK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4276
Mailing Address - Country:US
Mailing Address - Phone:805-892-8111
Mailing Address - Fax:805-892-8333
Practice Address - Street 1:2323 OAK PARK LN STE 202
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4276
Practice Address - Country:US
Practice Address - Phone:805-892-8111
Practice Address - Fax:805-892-8333
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154683207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology