Provider Demographics
NPI:1972528099
Name:CHAN, YUK-WAH N (MD)
Entity type:Individual
Prefix:
First Name:YUK-WAH
Middle Name:N
Last Name:CHAN
Suffix:
Gender:F
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:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-0561
Mailing Address - Country:US
Mailing Address - Phone:845-635-9417
Mailing Address - Fax:845-635-9419
Practice Address - Street 1:1539 MAIN ST
Practice Address - Street 2:SUITE C, FIRST FLOOR
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7834
Practice Address - Country:US
Practice Address - Phone:845-635-9417
Practice Address - Fax:845-635-9419
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CDPHPOther10045532
5375C1OtherEMPIRE BLUE
087116OtherMVP
087116OtherMVP
22L601Medicare ID - Type Unspecified