Provider Demographics
NPI:1932267796
Name:CHAN, RAYMOND K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 FACTORIA BLVD SE
Mailing Address - Street 2:#2B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-746-5907
Mailing Address - Fax:425-746-1688
Practice Address - Street 1:4140 FACTORIA BLVD SE
Practice Address - Street 2:#2B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-746-5907
Practice Address - Fax:425-746-1688
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist