| Provider / Organization | NPI | Date Certified |
|---|---|---|
| IVAN CHAN | 1306572359 | 2022-07-30 |
Ivan Chan is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1306572359. Registration indicates Ivan Chan is a provider of access to dentists-general services with a specialization in Dental Providers, Dentist (Dental Providers, Dentist) (Dentist: General Practice, ) (Dental, ) (Dentist General Practice, Dental Providers) (Dentist, )
| Entity Type | Individual |
| Provider Name | Dr. Ivan Chan |
| Practice Office Address | 255 S GRAND AVE STE 204 LOS ANGELES, CA US |
| Practice Office Telephone | 9166901508 |
| Mailing Address | 6704 ESKRIDGE WAY ELK GROVE, CA 957586361 US |
| Business Telephone | 9166901508 |
| Code | Practice | License No State |
|---|---|---|
| 1223G0001X PRIMARY | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist: General Practice Dental Dentist General Practice Dental Providers Dentist | 107682
CA |