Individual
SOTHEARY CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1787 ALLENDALE FAIRFAX HWY, FAIRFAX, SC 29827-9133
(803) 632-1176
(803) 632-2410
Mailing address
PO BOX 218, FAIRFAX, SC 29827-0218
(803) 632-1176
(803) 632-2410
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1272
SC
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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