Provider Demographics
NPI:1558313932
Name:CHAN, ROBIN YC (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:YC
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 1:1508 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-376-3383
Mailing Address - Fax:718-787-9875
Practice Address - Street 1:1508 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3808
Practice Address - Country:US
Practice Address - Phone:718-376-3383
Practice Address - Fax:718-787-9875
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY092ABEM171Medicare PIN