Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036.144383 | IL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 293812 | NY |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.120793 | OH |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MT193950 | PA |
NPI | 1053577924 |
---|---|
Provider Name | Dr. Jon Michael Chan |
First Address | Buffalo, NY 14222-2041 |
Second Address | Buffalo, NY 14222-2041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
293812 | NYS LICENSE (01) | NY |
PENDING | (05) | OH |