Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | CHANK2 | NY |
Y | 1223X0008X | Oral and Maxillofacial Radiology | 056437-1 | NY |
NPI | 1124436134 |
---|---|
Provider Name | Dr. King Chong Chan |
First Address | New York, NY 10010-4020 |
Second Address | New York, NY 10010-4020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2014 |
Last Update Date | 23/07/2014 |