MEDICARE: KWAI-TUNG CHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	K8723	TX

General Provider Information

NPI Number	:	1114979309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWAI-TUNG CHAN M.D.

Provider Business Mailing Address
First Line	:	1709 DRYDEN RD
Second Line	:	SUITE # 725
City	:	HOUSTON
State	:	TX
Zip	:	77030-2400
Country	:	US
Telephone Number	:	713-798-8364
Fax Number	:	713-798-7259

Provider Business Practice Location Address
First Line	:	6620 MAIN ST
Second Line	:	SUITE #1350
City	:	HOUSTON
State	:	TX
Zip	:	77030-2348
Country	:	US
Telephone Number	:	713-798-6198
Fax Number	:	713-798-4688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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