Healthcare Provider Details

I. General information

NPI: 1164846473
Provider Name (Legal Business Name): MING CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6639 ALDERTON ST
REGO PARK NY
11374-5205
US

IV. Provider business mailing address

6639 ALDERTON ST
REGO PARK NY
11374-5205
US

V. Phone/Fax

Practice location:
  • Phone: 718-271-1124
  • Fax:
Mailing address:
  • Phone: 718-271-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAFE44369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: