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Individual
DR. WILSON CHAN
Active
Individual
DR. WILSON CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS041841
PA
1223G0001X
General Practice Dentistry
Primary
DS041841
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1036229380001
—
PA
Enumeration date
06/11/2017
Last updated
01/06/2020
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