Provider Demographics
NPI:1831163021
Name:CHAN, MICHAEL LAP (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAP
Last Name:CHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 S NOGALES AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748
Mailing Address - Country:US
Mailing Address - Phone:626-913-0222
Mailing Address - Fax:626-854-8622
Practice Address - Street 1:1725 S NOGALES AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748
Practice Address - Country:US
Practice Address - Phone:626-913-0222
Practice Address - Fax:626-854-8622
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36344OtherMEDICAL