Provider Demographics
NPI:1083775233
Name:CHAN, WING CHIU (MD)
Entity Type:Individual
Prefix:
First Name:WING
Middle Name:CHIU
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-8754
Mailing Address - Country:US
Mailing Address - Phone:626-573-4046
Mailing Address - Fax:626-441-7316
Practice Address - Street 1:1668 S GARFIELD AVE # 100
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5413
Practice Address - Country:US
Practice Address - Phone:626-308-9000
Practice Address - Fax:626-441-7316
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56121207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE32618Medicare UPIN