Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 045149 | NY |
NPI | 1093769317 |
---|---|
Provider Name | Michael H. Chan |
First Address | New York, NY 10023-7462 |
Second Address | Brooklyn, NY 11209-7104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 08/07/2007 |