Individual
DR. TIMOTHY CHAN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-1954
(253) 968-1110
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD416
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790955367
NPI
FL
01
—
6364940001
PTAN
FL
01
—
CZ549Z
MCR
FL
Enumeration date
03/10/2008
Last updated
11/19/2024
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