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General NPI Number Information
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NPI Number | 1427217603
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Entity Type | Individual
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Provider Name | JENNY SANG CHAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 223 N VAN DIEN AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-2726
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Country | US
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Telephone | 917-930-5465
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Fax |
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Provider Business Mailing Address
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Address Line | 409 WESTVIEW PL
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City | FORT LEE
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State | NJ
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Zip | 07024-3916
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Country | US
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Telephone | 917-930-5465
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 60 242456
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License Number State | NY
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