Provider Demographics
NPI:1386121697
Name:CHAN, SAMANTHA SANH (BSN, CCRN, MSN, FNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SANH
Last Name:CHAN
Suffix:
Gender:F
Credentials:BSN, CCRN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W SAN LORENZO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6225
Mailing Address - Country:US
Mailing Address - Phone:714-878-0611
Mailing Address - Fax:
Practice Address - Street 1:1525 W SAN LORENZO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6225
Practice Address - Country:US
Practice Address - Phone:714-878-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily