Lorie Lee Chan, DDS
Individual provider Active NPI Dentist · Vandenberg Afb, CA
NPI 1760477384 · NPPES record last updated Jul 17, 2009
Key facts
- NPI
- 1760477384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 51556 (CA)
- Practice address
- 338 S Dakota Ave
Ste 1-1300
Vandenberg Afb, CA 93437-6307 - Phone
- (323) 788-6953
- NPI assigned
- Sep 20, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51556 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 51556 | CA | Yes |
Addresses
Primary practice location
338 S Dakota Ave
Ste 1-1300
Vandenberg Afb, CA 93437-6307
Mailing address
338 S Dakota Ave
Ste 1-1300
Vandenberg Afb, CA 93437-6307
Phone (323) 788-6953
Other providers in Vandenberg Afb, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.