Individual
RYLAN CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1623 S WELLS AVE, MERIDIAN, ID 83642-5040
(208) 489-1450
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2557
AZ
363A00000X
Physician Assistant
Primary
PA-1342
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
950552
—
AZ
Enumeration date
06/28/2006
Last updated
07/20/2021
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