Provider Demographics
NPI:1326243767
Name:CHAN, MABEL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MABEL
Middle Name:ANN
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1001 POTRERO AVE. BLDG. 5, MS6E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:628-206-8361
Mailing Address - Fax:628-206-3686
Practice Address - Street 1:1001 POTRERO AVE BLDG. 5, #6M
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:628-206-8361
Practice Address - Fax:628-206-3686
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics