Provider Demographics
NPI:1487847505
Name:CHAN, WAH KWAN (OMD)
Entity Type:Individual
Prefix:DR
First Name:WAH KWAN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-2119
Mailing Address - Country:US
Mailing Address - Phone:415-956-2699
Mailing Address - Fax:415-956-1268
Practice Address - Street 1:18 WAVERLY PL
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-2119
Practice Address - Country:US
Practice Address - Phone:415-956-2699
Practice Address - Fax:415-956-1268
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist