MEDICARE: YUK-WAH N 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	207Q00000X	Family Medicine Physician	169558	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	CDPHP	OTHER	10045532
2	5375C1	OTHER	EMPIRE BLUE
3	087116	OTHER	MVP

General Provider Information

NPI Number	:	1972528099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUK-WAH N CHAN MD

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	:
Name	:
Credential	:
Telephone Number	:

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

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