MEDICARE: YUK-WAH CHAN, MD, PC

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	207Q00000X	Family Medicine Physician	169558	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3742839	OTHER	CIGNA
2	4C8327	OTHER	HEALTHNET
3	M175	OTHER	CDPHP
4	5996621	OTHER	GHI-PPO
5	1864204	OTHER	UNITED HEALTHCARE
6	P3249514	OTHER	OXFORD
7	80531	OTHER	GHI-HMO

General Provider Information

NPI Number	:	1215952478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YUK-WAH CHAN, MD, PC

Provider Business Mailing Address
First Line	:	PO BOX 561
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-0561
Country	:	US
Telephone Number	:	845-635-9417
Fax Number	:	845-635-9419

Provider Business Practice Location Address
First Line	:	1539 MAIN ST
Second Line	:	SUITE C, FIRST FLOOR
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-7834
Country	:	US
Telephone Number	:	845-635-9417
Fax Number	:	845-635-9419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YUK-WAH CHAN
Credential	:	MD
Telephone Number	:	845-635-9417

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	04/28/2012

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