Provider Demographics
NPI:1023288263
Name:CHAN, CYNTHIA (LMP)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2035 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8841
Mailing Address - Country:US
Mailing Address - Phone:360-544-5852
Mailing Address - Fax:360-544-5852
Practice Address - Street 1:840 SE BAYSHORE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4062
Practice Address - Country:US
Practice Address - Phone:360-544-5852
Practice Address - Fax:360-544-5852
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist