Provider Demographics
NPI:1639134307
Name:CHAN, RICKY YUK KIU (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:YUK KIU
Last Name:CHAN
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:CTR FOR BLD AND CLOT DISORDERS, SUITE B-549, MMC 713
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-6455
Mailing Address - Fax:612-625-4955
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:CTR FOR BLD AND CLOT DISORDERS, SUITE B-549, MMC 713
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-626-6455
Practice Address - Fax:612-625-4955
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2009-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN206936900Medicaid
MN206936900Medicaid
MN970002282Medicare ID - Type Unspecified