Basic Information
| Provider Information | |||||||||
| NPI: | 1013476910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | CHU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 243 21ST AVE APT 1 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941212184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153877698 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1735 MISSION ST STE 3280 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152261775 | ||||||||
| FaxNumber: | 4157954798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2019 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.