Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 275029 | MA |
NPI | 1013275114 |
---|---|
Provider Name | Wayne Wayfu Chan |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 27/10/2020 |