Provider Demographics
NPI:1396494605
Name:CHAN, KATELYN SUSAN
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:SUSAN
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:SUSAN
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1257 MILLS ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3240
Mailing Address - Country:US
Mailing Address - Phone:907-230-4214
Mailing Address - Fax:
Practice Address - Street 1:291 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5101
Practice Address - Country:US
Practice Address - Phone:650-723-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program