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NPI Code Detail

MEDICARE: YU TUNG CLEMENT CHAN

MEDICARE: YU TUNG CLEMENT 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1366692030
Entity Type Code : Individual
Provider Name (Legal Business Name) : YU TUNG CLEMENT CHAN
Provider Business Mailing Address
First Line : 2043 COLLEGE WAY
Second Line : UC# 2009
City : FOREST GROVE
State : OR
Zip : 97116-1756
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2043 COLLEGE WAY
Second Line : UC# 2009
City : FOREST GROVE
State : OR
Zip : 97116-1756
Country : US
Telephone Number : 971-227-9693
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2008
Last Update Date : 09/30/2008

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Directions to “ YU TUNG CLEMENT CHAN ” Practice Location

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