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General NPI Number Information
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NPI Number | 1932488574
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Entity Type | Individual
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Provider Name | DEREK VICTOR CHAN M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2011
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 245 5TH AVE FL 3
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City | NEW YORK
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State | NY
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Zip | 10016-8728
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Country | US
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Telephone | 212-606-3780
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Fax | 212-606-3785
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Provider Business Mailing Address
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Address Line | 119 W 57TH ST STE 212
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City | NEW YORK
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State | NY
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Zip | 10019-2302
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Country | US
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Telephone | 212-606-3780
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | DR.0055946
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 279602
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License Number State | NY
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