Provider Demographics
NPI:1376033084
Name:CHAN, WILLIAM (PSYD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 MAHLER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1640
Mailing Address - Country:US
Mailing Address - Phone:650-822-1057
Mailing Address - Fax:650-563-5570
Practice Address - Street 1:877 MAHLER RD STE 160
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1640
Practice Address - Country:US
Practice Address - Phone:650-822-1057
Practice Address - Fax:650-563-5570
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33550103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical