Provider Demographics
NPI:1447267950
Name:CHAN, RICCI (DMD)
Entity type:Individual
Prefix:DR
First Name:RICCI
Middle Name:
Last Name:CHAN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N SAN MATEO DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2492
Mailing Address - Country:US
Mailing Address - Phone:650-697-9497
Mailing Address - Fax:650-274-0205
Practice Address - Street 1:424 N SAN MATEO DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2492
Practice Address - Country:US
Practice Address - Phone:650-697-9497
Practice Address - Fax:650-274-0205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist