Provider Demographics
NPI:1891791877
Name:CHAN, WAI-LAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WAI-LAM
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 NORIEGA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4431
Mailing Address - Country:US
Mailing Address - Phone:415-759-3777
Mailing Address - Fax:415-759-6368
Practice Address - Street 1:1431 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4431
Practice Address - Country:US
Practice Address - Phone:415-759-3777
Practice Address - Fax:415-759-6368
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0159135Medicaid
CA0159135Medicaid
CAH07991Medicare UPIN