Provider Demographics
NPI:1467553289
Name:SIY-HIAN, BIENVENIDO CHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BIENVENIDO
Middle Name:CHAN
Last Name:SIY-HIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 A OWEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3417
Mailing Address - Country:US
Mailing Address - Phone:910-484-1586
Mailing Address - Fax:910-483-5639
Practice Address - Street 1:508 A OWEN DRIVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3417
Practice Address - Country:US
Practice Address - Phone:910-484-1586
Practice Address - Fax:910-483-5639
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76682Medicaid
201831Medicare ID - Type Unspecified
C85448Medicare UPIN