Provider Demographics
NPI:1467531723
Name:CHAN, EVELYN MAY-LAN (LAC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:MAY-LAN
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 JAMES LN
Mailing Address - Street 2:
Mailing Address - City:KINDERHOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12106-2313
Mailing Address - Country:US
Mailing Address - Phone:646-383-7264
Mailing Address - Fax:646-415-8373
Practice Address - Street 1:51 E 42ND ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5404
Practice Address - Country:US
Practice Address - Phone:646-383-7264
Practice Address - Fax:646-415-8373
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist