Provider Demographics
NPI:1235345943
Name:CHAN, RAYMOND YAN-KWONG (DC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:YAN-KWONG
Last Name:CHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 8TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3963
Mailing Address - Country:US
Mailing Address - Phone:510-251-2288
Mailing Address - Fax:510-835-7700
Practice Address - Street 1:435 8TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3963
Practice Address - Country:US
Practice Address - Phone:510-251-2288
Practice Address - Fax:510-835-7700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18757111NX0100X, 111NX0800X, 111NI0013X
CAMTA22600246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Not Answered111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Not Answered246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18757OtherCHIROPRACTOR
CAMTA22600OtherCLINICAL LAB.SCIENTIST
WACH00002209OtherCHIROPRACTOR