Provider Demographics
NPI:1487268264
Name:CHAN, STEFAN (RN)
Entity type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 BONIFACIO ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2260
Mailing Address - Country:US
Mailing Address - Phone:925-255-3333
Mailing Address - Fax:
Practice Address - Street 1:1969 BONIFACIO ST APT 4
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2260
Practice Address - Country:US
Practice Address - Phone:925-255-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95181410163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical