Provider Demographics
NPI:1699157222
Name:CHAN, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRIPLER ARMY MEDICAL CENTER GME
Mailing Address - Street 2:1 JARRETT WHITE ROAD
Mailing Address - City:TAMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859
Mailing Address - Country:US
Mailing Address - Phone:915-742-2597
Mailing Address - Fax:915-742-6668
Practice Address - Street 1:TRIPLER ARMY MEDICAL CENTER GME
Practice Address - Street 2:1 JARRETT WHITE ROAD
Practice Address - City:TAMC
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-433-6588
Practice Address - Fax:915-742-6668
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program