Provider Demographics
NPI:1841293578
Name:CHAN, RAYMOND MAN-SHU (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MAN-SHU
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18522
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-8522
Mailing Address - Country:US
Mailing Address - Phone:714-282-7800
Mailing Address - Fax:
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:STE 228
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-5213
Practice Address - Country:US
Practice Address - Phone:714-282-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CA346831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice