Provider Demographics
NPI:1740852292
Name:CHAN, ASHLEY S (DDS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:S
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VERBALEE LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-7435
Mailing Address - Country:US
Mailing Address - Phone:650-867-0681
Mailing Address - Fax:
Practice Address - Street 1:181 2ND AVE STE 575
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3838
Practice Address - Country:US
Practice Address - Phone:650-532-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist