Provider Demographics
NPI:1003848177
Name:CHAN, DAVID TIT-CHIU (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TIT-CHIU
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 HARDIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-7087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:702-260-6332
Practice Address - Street 1:106 E LAKE MEAD PKWY
Practice Address - Street 2:#107
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5534
Practice Address - Country:US
Practice Address - Phone:702-616-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502315Medicaid
NVA40583Medicare UPIN