Provider Demographics
NPI:1164554630
Name:CHAN, YEH CHONG (OMD PHD LAC)
Entity Type:Individual
Prefix:DR
First Name:YEH
Middle Name:CHONG
Last Name:CHAN
Suffix:
Gender:M
Credentials:OMD PHD LAC
Other - Prefix:DR
Other - First Name:Y
Other - Middle Name:C
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OMD, PHD LAC
Mailing Address - Street 1:11125 ROCKVILLE PIKE STE G4
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-881-7866
Mailing Address - Fax:301-881-7867
Practice Address - Street 1:11125 ROCKVILLE PIKE STE G4
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-881-7866
Practice Address - Fax:301-881-7867
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-115171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist