Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 18377 | NE |
NPI | 1174577886 |
---|---|
Provider Name | Wing C Chan |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557547 | (05) | NE |
E69257 | (02) | NE |