Provider Demographics
NPI:1033354428
Name:CHAN, WAI PING (DO)
Entity Type:Individual
Prefix:
First Name:WAI
Middle Name:PING
Last Name:CHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13633 37TH AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4562
Mailing Address - Country:US
Mailing Address - Phone:718-762-6462
Mailing Address - Fax:187-509-6467
Practice Address - Street 1:13633 37TH AVE STE 4A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-762-6462
Practice Address - Fax:187-509-6467
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250588207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology