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General NPI Number Information
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NPI Number | 1205791118
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Entity Type | Individual
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Provider Name | JENSON WACHENG CHAN
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Gender | Male
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 1468 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10029-6508
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Country | US
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Telephone | 212-241-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 YORK AVE APT 5R
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City | NEW YORK
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State | NY
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Zip | 10021-3154
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Country | US
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Telephone | 929-313-8025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F433433
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License Number State | NY
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