Provider Demographics
NPI:1851728463
Name:CHAN, MINGMING (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MINGMING
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MINGMING
Other - Middle Name:
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4018 9TH AVE
Mailing Address - Street 2:PLP
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3886
Mailing Address - Country:US
Mailing Address - Phone:347-422-3287
Mailing Address - Fax:
Practice Address - Street 1:4018 9TH AVE
Practice Address - Street 2:PLP
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3886
Practice Address - Country:US
Practice Address - Phone:347-422-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant