Provider Demographics
NPI:1780343582
Name:JEANNIE KUAN YEE CHAN LLC
Entity type:Organization
Organization Name:JEANNIE KUAN YEE CHAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MFT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE KUAN YEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-223-7374
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-0612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 635
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4322
Practice Address - Country:US
Practice Address - Phone:808-223-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty