Provider Demographics
NPI:1962614768
Name:CHAN, DENIS TC
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:TC
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-748 HIKIMOE ST. STE B
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3350
Mailing Address - Country:US
Mailing Address - Phone:808-671-7155
Mailing Address - Fax:808-671-7155
Practice Address - Street 1:94-748 HIKIMOE ST STE B
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3350
Practice Address - Country:US
Practice Address - Phone:808-671-7155
Practice Address - Fax:808-671-7155
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2065170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI030931-01Medicaid
HI0003437-1OtherHMSA,Q,HMA,UHA
HI030931-01Medicaid