Healthcare Provider Details

I. General information

NPI: 1992458665
Provider Name (Legal Business Name): CHING FUNG CHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E NC HIGHWAY 54 STE 100
DURHAM NC
27713-2490
US

IV. Provider business mailing address

249 E NC HIGHWAY 54 STE 100
DURHAM NC
27713-2490
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 980-785-1113
  • Fax: 980-785-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9564
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84107
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: