Provider Demographics
NPI:1578900452
Name:CHAN, LYDIA HUI-LING (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:HUI-LING
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 SAN BRUNO AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134
Mailing Address - Country:US
Mailing Address - Phone:415-713-3807
Mailing Address - Fax:
Practice Address - Street 1:2674 SAN BRUNO AVENUE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134
Practice Address - Country:US
Practice Address - Phone:415-750-5909
Practice Address - Fax:415-750-5910
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137928207R00000X
CAA137928208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine