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General NPI Number Information
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NPI Number | 1801168224
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Entity Type | Individual
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Provider Name | SAMSON CHAN MD
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Gender | Male
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Dates
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Enumeration Date | 01/31/2012
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 553 W 31ST ST STE 1
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City | CHICAGO
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State | IL
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Zip | 60616-4992
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Country | US
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Telephone | 773-966-9978
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Fax |
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Provider Business Mailing Address
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Address Line | 474 N LAKE SHORE DR APT 5206
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City | CHICAGO
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State | IL
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Zip | 60611-6494
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Country | US
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Telephone | 773-966-9978
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301093219
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License Number State | MI
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