Provider Demographics
NPI:1508129057
Name:CHAN, YVONNE TSZ FAN (CASE COORDINATOR)
Entity Type:Individual
Prefix:MS
First Name:YVONNE TSZ FAN
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:CASE COORDINATOR
Other - Prefix:MS
Other - First Name:TSZ FAN
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:116 WEST 32ND STREET, 8/F
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-564-2350
Mailing Address - Fax:212-564-5896
Practice Address - Street 1:3267 47TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1707
Practice Address - Country:US
Practice Address - Phone:347-891-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator