Individual
DR. BENJAMIN RUSSELL CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 KOMAS DR, SUITE 200, SALT LAKE CITY, UT 84108-1215
(801) 581-5515
Mailing address
2145 HANNIBAL ST, SALT LAKE CITY, UT 84106-4101
(801) 581-5515
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101240110
VA
Other
Enumeration date
04/19/2007
Last updated
11/12/2021
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