Provider Demographics
NPI:1033147335
Name:CHAN, FUCHAT (MD)
Entity Type:Individual
Prefix:
First Name:FUCHAT
Middle Name:
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 1:91-2139 FT. WEAVER RD., #102
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3608
Mailing Address - Country:US
Mailing Address - Phone:808-671-6777
Mailing Address - Fax:
Practice Address - Street 1:91-2139 FT. WEAVER RD., #102
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3608
Practice Address - Country:US
Practice Address - Phone:808-671-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3276208000000X, 2080P0214X
CAA34951208000000X
WAMD00018470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
03963201Medicare ID - Type Unspecified
F50979Medicare UPIN