MEDICARE: YAN K CHAN

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1255898979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAN K CHAN

Provider Business Mailing Address
First Line	:	6504 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6504 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3931
Country	:	US
Telephone Number	:	718-837-2513
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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Directions to “ YAN K CHAN ” Practice Location

Language	Start Address	Practice Location

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