Healthcare Provider Details

I. General information

NPI: 1033449608
Provider Name (Legal Business Name): BETTY LIWAH CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 BAY STREET 303
TORONTO ONTARIO
M5S3A5
CA

IV. Provider business mailing address

1033 BAY STREET 303
TORONTO ONTARIO
M5S3A5
CA

V. Phone/Fax

Practice location:
  • Phone: 416-515-0007
  • Fax: 416-926-0504
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number154593
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: