Provider Demographics
NPI:1437435435
Name:CHAN, YIN-WAH WENDY (L AC)
Entity Type:Individual
Prefix:MS
First Name:YIN-WAH
Middle Name:WENDY
Last Name:CHAN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:MS
Other - First Name:YIN WAH
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:100 OVERLOOK TER APT 424
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3860
Mailing Address - Country:US
Mailing Address - Phone:646-709-1657
Mailing Address - Fax:917-521-2555
Practice Address - Street 1:757 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1904
Practice Address - Country:US
Practice Address - Phone:845-821-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist