Provider Demographics
NPI:1417972423
Name:CHAN, DORIS GEE (DTR)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:GEE
Last Name:CHAN
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:MISS
Other - First Name:DORIS
Other - Middle Name:JANE
Other - Last Name:GEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20946 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5345
Mailing Address - Country:US
Mailing Address - Phone:510-583-9690
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1545
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:415-750-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA948210136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered