Provider Demographics
NPI:1659458289
Name:CHAN, YIM H (MD)
Entity Type:Individual
Prefix:DR
First Name:YIM
Middle Name:H
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3699
Mailing Address - Fax:415-252-3015
Practice Address - Street 1:1990 41ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1101
Practice Address - Country:US
Practice Address - Phone:415-753-7255
Practice Address - Fax:415-753-0164
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG610952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610950Medicare PIN
CAE56218Medicare UPIN