Basic Information
| Provider Information | |||||||||
| NPI: | 1639547490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5882 BOLSA AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926495702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148985732 | ||||||||
| FaxNumber: | 7149014058 | ||||||||
| Practice Location | |||||||||
| Address1: | 19520 NORDHOFF ST STE 5 | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913242451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187349124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2015 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 3067 | CA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.