Individual
DR. MICAH CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.S.
Contact information
Practice address
6601 LYNDALE AVE S, RICHFIELD, MN 55423-2477
(612) 243-9357
Mailing address
8301 STANLEY RD, APT #114, BLOOMINGTON, MN 55437-1282
(612) 910-6203
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
S99
MN
Other
Enumeration date
09/16/2015
Last updated
09/16/2015
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