Provider Demographics
NPI:1881865111
Name:DR. IGOR CHAN MIN M.D.
Entity Type:Organization
Organization Name:DR. IGOR CHAN MIN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN MIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-687-8669
Mailing Address - Street 1:130 KENSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3025
Mailing Address - Country:US
Mailing Address - Phone:718-687-8669
Mailing Address - Fax:718-332-1993
Practice Address - Street 1:130 KENSINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3025
Practice Address - Country:US
Practice Address - Phone:718-687-8669
Practice Address - Fax:718-332-1993
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. IGOR CHAN MIN M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH35368Medicare UPIN
NYWZW2Z1Medicare PIN
NY04828Medicare PIN