Provider Demographics
NPI:1174401038
Name:CHAN, SABRINA PEONY (DDS)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:PEONY
Last Name:CHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 VILLAGE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3905
Mailing Address - Country:US
Mailing Address - Phone:858-877-0127
Mailing Address - Fax:
Practice Address - Street 1:12677 ALCOSTA BLVD STE 415
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4423
Practice Address - Country:US
Practice Address - Phone:925-830-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS112231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist