Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 28435 | SC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 9600879 | NC |
NPI | 1114900826 |
---|---|
Provider Name | Barry B.k. Chan |
First Address | Charlotte, NC 28260-0447 |
Second Address | Rock Hill, SC 29732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 14/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8921992 | (05) | NC |
E46898 | (02) | NC |
N00879 | (05) | SC |