Provider Demographics
NPI:1740996446
Name:CHAN, MONICA MIMI
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MIMI
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WILLOW PASS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7923
Mailing Address - Country:US
Mailing Address - Phone:925-825-1793
Mailing Address - Fax:
Practice Address - Street 1:39420 LIBERTY ST STE 252
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2297
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:510-745-9152
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program