Provider Demographics
NPI:1831753839
Name:CHAN, DANIEL YUE-KING (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:YUE-KING
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S CATARACT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2902
Mailing Address - Country:US
Mailing Address - Phone:424-645-7575
Mailing Address - Fax:424-644-2575
Practice Address - Street 1:430 S CATARACT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2902
Practice Address - Country:US
Practice Address - Phone:424-645-7575
Practice Address - Fax:424-644-2575
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADRH065247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician