Provider Demographics
NPI:1477851103
Name:CHAN, ANNA (MD)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 CHERRY AVE
Mailing Address - Street 2:UNIT 1E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3291
Mailing Address - Country:US
Mailing Address - Phone:718-358-0038
Mailing Address - Fax:718-358-0043
Practice Address - Street 1:14105 CHERRY AVE
Practice Address - Street 2:UNIT 1E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3291
Practice Address - Country:US
Practice Address - Phone:718-358-0038
Practice Address - Fax:718-358-0043
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY265458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine