Provider Demographics
NPI:1881796670
Name:CHAN, CYNTHIA LOUIE (RTC, CTRS)
Entity type:Individual
Prefix:MR
First Name:CYNTHIA
Middle Name:LOUIE
Last Name:CHAN
Suffix:
Gender:F
Credentials:RTC, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1103
Mailing Address - Country:US
Mailing Address - Phone:415-504-9353
Mailing Address - Fax:
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:BLDG. #331
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3062-T225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist