Provider Demographics
NPI:1104843101
Name:CHAN-COLENBRANDER, SUK YIN (MD)
Entity type:Individual
Prefix:DR
First Name:SUK YIN
Middle Name:
Last Name:CHAN-COLENBRANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUK-YIN
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10961 CLUB WEST PARKWAT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5866
Mailing Address - Country:US
Mailing Address - Phone:815-398-3277
Mailing Address - Fax:815-986-1448
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-672-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025616207R00000X
NC2008-01853207R00000X
IL036124627207R00000X
MN46951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21503Medicare UPIN