Provider Demographics
NPI:1730298373
Name:CHAN, RAYMOND YUEN-FONG (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:YUEN-FONG
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 1:4619 CONVOY ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2318
Mailing Address - Country:US
Mailing Address - Phone:858-627-9988
Mailing Address - Fax:
Practice Address - Street 1:4619 CONVOY ST
Practice Address - Street 2:SUITE G
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2318
Practice Address - Country:US
Practice Address - Phone:858-627-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G442490Medicaid
CAA49595Medicare UPIN
CA00G442490Medicaid