Provider Demographics
NPI:1518658038
Name:CHAN, SIU WAI
Entity Type:Individual
Prefix:
First Name:SIU WAI
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 61ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4211
Mailing Address - Country:US
Mailing Address - Phone:347-689-9222
Mailing Address - Fax:347-689-9220
Practice Address - Street 1:761 61ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4211
Practice Address - Country:US
Practice Address - Phone:347-689-9222
Practice Address - Fax:347-689-9220
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant