Provider Demographics
NPI:1780636696
Name:CHAN, DAVID YAT SAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:YAT SAN
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YAT SAN
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:600 COMMUNITY DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3825
Mailing Address - Country:US
Mailing Address - Phone:516-823-8010
Mailing Address - Fax:516-823-8290
Practice Address - Street 1:450 LAKEVILLE RD
Practice Address - Street 2:SUITE M41
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1117
Practice Address - Country:US
Practice Address - Phone:516-734-8500
Practice Address - Fax:516-734-8538
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57139208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024902500Medicaid
MDH32638Medicare UPIN
MDKS16A139Medicare ID - Type Unspecified