1215952478 NPI number — YUK-WAH CHAN, MD, PC

Table of content: (NPI 1215952478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215952478 NPI number — YUK-WAH CHAN, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YUK-WAH CHAN, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215952478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 561
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANT VALLEY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12569-0561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-635-9417
Provider Business Mailing Address Fax Number:
845-635-9419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1539 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C, FIRST FLOOR
Provider Business Practice Location Address City Name:
PLEASANT VALLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12569-7834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-635-9417
Provider Business Practice Location Address Fax Number:
845-635-9419
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAN
Authorized Official First Name:
YUK-WAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-635-9417

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  169558 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3742839 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4C8327 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: M175 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5996621 . This is a "GHI-PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1864204 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3249514 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80531 . This is a "GHI-HMO" identifier . This identifiers is of the category "OTHER".




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