Provider Demographics
NPI:1588873772
Name:CHAN, WING YUE
Entity type:Individual
Prefix:
First Name:WING
Middle Name:YUE
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 STATE ROUTE 27
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1358
Mailing Address - Country:US
Mailing Address - Phone:732-821-2800
Mailing Address - Fax:732-422-2274
Practice Address - Street 1:3391 STATE ROUTE 27
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1358
Practice Address - Country:US
Practice Address - Phone:732-821-2800
Practice Address - Fax:732-422-2274
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0201091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice