Provider Demographics
NPI:1659670396
Name:CHAN, FUNG MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:FUNG
Middle Name:MICHAEL
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:128 MOTT ST
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5540
Mailing Address - Country:US
Mailing Address - Phone:212-343-8399
Mailing Address - Fax:212-343-1386
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-343-8399
Practice Address - Fax:212-343-1386
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY266192-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology