Provider Demographics
NPI:1639405038
Name:CHAN, PING K
Entity Type:Individual
Prefix:MR
First Name:PING
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 SE 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1412
Mailing Address - Country:US
Mailing Address - Phone:503-980-8760
Mailing Address - Fax:503-788-2913
Practice Address - Street 1:3127 SE 89TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1412
Practice Address - Country:US
Practice Address - Phone:503-980-8760
Practice Address - Fax:503-788-2913
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist