Provider Demographics
NPI:1669746939
Name:CHAN, AMANDA MICHELE (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MICHELE
Last Name:CHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 WOODED HILLS CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7246
Mailing Address - Country:US
Mailing Address - Phone:510-421-0338
Mailing Address - Fax:
Practice Address - Street 1:820 WOODED HILLS CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7246
Practice Address - Country:US
Practice Address - Phone:510-421-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14507207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology