Provider Demographics
NPI:1538281530
Name:CHAN, WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WAI-SUN
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:8299 161ST AVE NE
Practice Address - Street 2:#101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3860
Practice Address - Country:US
Practice Address - Phone:425-881-8813
Practice Address - Fax:425-869-7201
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60097485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8894863Medicare PIN
WAG8897718Medicare PIN