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General NPI Number Information
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NPI Number | 1215952478
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Entity Type | Organization
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Legal Business Name | YUK-WAH CHAN, MD, PC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/28/2012
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Provider Practice Location Address
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Address Line | 1539 MAIN ST SUITE C, FIRST FLOOR
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City | PLEASANT VALLEY
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State | NY
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Zip | 12569-7834
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Country | US
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Telephone | 845-635-9417
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Fax | 845-635-9419
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Provider Business Mailing Address
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Address Line | PO BOX 561
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City | PLEASANT VALLEY
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State | NY
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Zip | 12569-0561
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Country | US
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Telephone | 845-635-9417
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Fax | 845-635-9419
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Authorized Official
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Title or Position | PRESIDENT
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Name | YUK-WAH CHAN
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Credential | MD
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Telephone | 845-635-9417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 169558
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License Number State | NY
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