Provider Demographics
NPI:1609863240
Name:CHAN, ALAN D S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D S
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000386332085B0100X, 2085N0700X, 2085R0202X
AK60712085R0202X
IDM-122792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8256349Medicaid
WA0175497OtherLNI-EVERGREEN RADIA
WA0386386OtherLNI-RADIA-REST OF WA
WA156861OtherPROV # LABOR & INDUSTRIES
AK1015963Medicaid
WA135543OtherPROV # LABOR & INDUSTRIES
WA0205686OtherLNI-SWEDISH RADIA
WA0381078OtherLNI-SOUTH SOUND
ID1609863240Medicaid
WA135542OtherPROV # LABOR & INDUSTRIES
AK1015963Medicaid
ID20004621Medicare PIN
P00197046Medicare PIN
WAAB39932Medicare PIN
WAAB25172Medicare PIN
WA205686OtherLNI PROVIDER ID
WA135543OtherPROV # LABOR & INDUSTRIES
WA175497OtherPROV # LABOR & INDUSTRIES
WAG98136Medicare UPIN
WA8857968Medicare PIN