Provider Demographics
NPI:1063443851
Name:CHAN-SMUTKO, GAYUN (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:GAYUN
Middle Name:
Last Name:CHAN-SMUTKO
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:GAYUN
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY 9A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-0292
Mailing Address - Fax:617-726-9418
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY 9A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-0292
Practice Address - Fax:617-726-9418
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS