Provider Demographics
NPI:1467648519
Name:CHAN, CHARMAINE SAN YEE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:SAN YEE
Last Name:CHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:610-772-6889
Mailing Address - Fax:313-887-1560
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-6380
Practice Address - Fax:215-871-6381
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013824208M00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11821841Medicaid
AZ366936Medicaid
CO23752769Medicaid
CO23752769Medicaid
320059Medicare Oscar/Certification
8EE975Medicare PIN