MEDICARE: YIK HAN CHAN MA, RD, CDN, CDCES

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	133V00000X	Registered Dietitian	1057883

General Provider Information

NPI Number	:	1699158352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YIK HAN CHAN MA, RD, CDN, CDCES

Provider Business Mailing Address
First Line	:	6721 EXETER ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4149
Country	:	US
Telephone Number	:	267-693-7088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6721 EXETER ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4149
Country	:	US
Telephone Number	:	267-693-7088
Fax Number	:	215-748-9237

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	02/13/2025

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