Healthcare Provider Details

I. General information

NPI: 1699738500
Provider Name (Legal Business Name): YUNG C. CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 1ST ST NW
PULASKI VA
24301-5603
US

IV. Provider business mailing address

101 1ST ST NW
PULASKI VA
24301-5603
US

V. Phone/Fax

Practice location:
  • Phone: 540-980-0550
  • Fax: 540-980-9141
Mailing address:
  • Phone: 540-980-0550
  • Fax: 540-980-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: