MEDICARE: DR. ENOCH CHUNG CHAN MD

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	207R00000X	Internal Medicine Physician	200300	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356309603	OTHER	NY	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356309603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENOCH CHUNG CHAN MD

Provider Business Mailing Address
First Line	:	1461 LAKELAND AVE UNIT 14
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-2174
Country	:	US
Telephone Number	:	631-218-8800
Fax Number	:	631-218-8801

Provider Business Practice Location Address
First Line	:	1461 LAKELAND AVE UNIT 14
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-2174
Country	:	US
Telephone Number	:	631-218-8800
Fax Number	:	631-218-8801

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/28/2008

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