Provider Demographics
NPI:1265461768
Name:CHAN, ALFRED H (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:H
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 111TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1303
Mailing Address - Country:US
Mailing Address - Phone:253-445-6613
Mailing Address - Fax:253-582-9172
Practice Address - Street 1:6323 111TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1303
Practice Address - Country:US
Practice Address - Phone:253-445-6613
Practice Address - Fax:253-582-9172
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019718207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH5285OtherREGENCE ID NUMBER
WA1105063Medicaid
WA91836OtherLABOR & INDUSTRIES ID NUM
WACH5285OtherREGENCE ID NUMBER
WA1105063Medicaid