Provider Demographics
NPI:1912795402
Name:CHAN, DOUGLAS YUK LAM
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:YUK LAM
Last Name:CHAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 BROAD RUN RD
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1329
Mailing Address - Country:US
Mailing Address - Phone:302-268-2397
Mailing Address - Fax:
Practice Address - Street 1:1516 BROAD RUN RD
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-1329
Practice Address - Country:US
Practice Address - Phone:302-268-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer