Provider Demographics
NPI:1073856084
Name:CHAN, CLARICE P (MD)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:P
Last Name:CHAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18543 YORBA LINDA BLVD # 395
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4135
Mailing Address - Country:US
Mailing Address - Phone:904-242-6638
Mailing Address - Fax:559-935-7118
Practice Address - Street 1:18543 YORBA LINDA BLVD # 395
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4135
Practice Address - Country:US
Practice Address - Phone:657-337-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1407112084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry