Healthcare Provider Details

I. General information

NPI: 1851917769
Provider Name (Legal Business Name): EDWIN YIRONG CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE STE 408
OKLAHOMA CITY OK
73103-2400
US

IV. Provider business mailing address

1211 N SHARTEL AVE STE 408
OKLAHOMA CITY OK
73103-2400
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4978
  • Fax: 405-772-4430
Mailing address:
  • Phone: 405-272-4978
  • Fax: 405-772-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47839
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number47839
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: