Healthcare Provider Details

I. General information

NPI: 1811512890
Provider Name (Legal Business Name): MARVYN ALLEN GAN CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

9229 QUEENS BLVD APT 15G
REGO PARK NY
11374-1061
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3000
  • Fax:
Mailing address:
  • Phone: 347-656-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: