Provider Demographics
NPI:1497828586
Name:CHAN, SHU WING (MD)
Entity Type:Individual
Prefix:MR
First Name:SHU WING
Middle Name:
Last Name:CHAN
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 1:929 CLAY STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1570
Mailing Address - Country:US
Mailing Address - Phone:415-956-6633
Mailing Address - Fax:415-956-6638
Practice Address - Street 1:929 CLAY STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1570
Practice Address - Country:US
Practice Address - Phone:415-956-6633
Practice Address - Fax:415-956-6638
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA301750207R00000X
CAA30175207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA001301750Medicaid
00A301750Medicare ID - Type Unspecified
CA001301750Medicaid