Provider Demographics
NPI:1588676134
Name:CHAN, CHARLES KING (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES KING
Middle Name:
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 1:78 BOWERY, 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-226-1221
Mailing Address - Fax:212-226-1127
Practice Address - Street 1:78 BOWERY, 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-226-1221
Practice Address - Fax:212-226-1127
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01849105Medicaid
NY01849105Medicaid
NY31E571Medicare ID - Type Unspecified