Provider Demographics
NPI:1285661587
Name:CHAN, RAPHAEL KOK CHIN (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:KOK CHIN
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 1:6363 DEZAVALA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2104
Mailing Address - Country:US
Mailing Address - Phone:210-225-5666
Mailing Address - Fax:
Practice Address - Street 1:2615 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9224
Practice Address - Country:US
Practice Address - Phone:713-228-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61523207Y00000X
TXG5874207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1781355Medicaid
LAI36056Medicare UPIN
LA4J7747460Medicare PIN
LA4J774Medicare ID - Type Unspecified
P00433495Medicare PIN