Provider Demographics
NPI:1831969989
Name:CHAN, FELICE ANN (LAC, MTOM)
Entity type:Individual
Prefix:
First Name:FELICE
Middle Name:ANN
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC, MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 VERONICA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-1134
Mailing Address - Country:US
Mailing Address - Phone:510-693-9077
Mailing Address - Fax:
Practice Address - Street 1:8737 VENICE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3259
Practice Address - Country:US
Practice Address - Phone:424-478-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19828171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist