Provider Demographics
NPI:1306014741
Name:CHAN, PING-CHIU (LIC AC)
Entity Type:Individual
Prefix:
First Name:PING-CHIU
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHINESE MEDICAL CENTER
Mailing Address - Street 2:38 BILLINGS ROAD
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171
Mailing Address - Country:US
Mailing Address - Phone:617-472-8807
Mailing Address - Fax:
Practice Address - Street 1:CHINESE MEDICAL CENTER
Practice Address - Street 2:38 BILLINGS ROAD
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-472-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist