Healthcare Provider Details

I. General information

NPI: 1942556485
Provider Name (Legal Business Name): WINSTON MING TAK CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N WALDROP DR STE 802
ARLINGTON TX
76012-4715
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 817-960-9138
  • Fax: 917-960-0006
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberQ9310
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberQ9310
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: