Provider Demographics
NPI:1497081962
Name:CHAN, YUEN KWAN (CNM)
Entity Type:Individual
Prefix:
First Name:YUEN KWAN
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 81ST ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2108
Mailing Address - Country:US
Mailing Address - Phone:917-915-5055
Mailing Address - Fax:718-233-3084
Practice Address - Street 1:1672 81ST ST APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2108
Practice Address - Country:US
Practice Address - Phone:917-915-5055
Practice Address - Fax:718-233-3084
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001357367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMC2053938OtherDEA