Provider Demographics
NPI:1447419700
Name:WILLIAM K CHAN DENTIST PC
Entity Type:Organization
Organization Name:WILLIAM K CHAN DENTIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:646-613-8888
Mailing Address - Street 1:80 BOWERY SUITE 300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:646-613-8888
Mailing Address - Fax:646-613-0783
Practice Address - Street 1:80 BOWERY SUITE 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:646-613-8888
Practice Address - Fax:646-613-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0492541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02162710Medicaid