Individual
JESSICA K CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
700 NE 87TH AVE, VANCOUVER, WA 98664-1913
(360) 882-2778
(360) 604-1743
Mailing address
PO BOX 873010, VANCOUVER, WA 98687-3010
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
OP60758015
WA
390200000X
Student in an Organized Health Care Education/Training Program
PG162770
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2063530
—
WA
Enumeration date
06/03/2013
Last updated
07/21/2022
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