Provider Demographics
NPI:1346232238
Name:AU, YEE-WAH CHAN
Entity Type:Individual
Prefix:PROF
First Name:YEE-WAH
Middle Name:CHAN
Last Name:AU
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:YEE-WAH CHAN
Other - Last Name:AU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13839 ROSETTA DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2589
Mailing Address - Country:US
Mailing Address - Phone:281-890-2381
Mailing Address - Fax:
Practice Address - Street 1:7112 LYONS AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-5361
Practice Address - Country:US
Practice Address - Phone:713-675-2625
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143578Medicaid