Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 8690 | HI |
N | 207RC0000X | Internist - Cardiovascular Disease | G71314 | CA |
NPI | 1003841834 |
---|---|
Provider Name | Dr. Michael Wayne Chan |
First Address | Aiea, HI 96701-4713 |
Second Address | Aiea, HI 96701-4713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 26/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F77257 | (02) | HI |