Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 183058 | NY |
NPI | 1396730693 |
---|---|
Provider Name | Siu-Pun Chan |
First Address | Staten Island, NY 10310-2512 |
Second Address | Staten Island, NY 10310-2512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F41735 | (02) | NY |