Individual
VISOTH CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
26732 CROWN VALLEY PKWY, SUITE 317, MISSION VIEJO, CA 92691-6306
(949) 364-2525
(949) 364-3322
Mailing address
1725 E JACKSON ST, LONG BEACH, CA 90805-6221
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5026
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HI205Z
PTAN
CA
Enumeration date
11/15/2012
Last updated
08/05/2013
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