Provider Demographics
NPI:1184063463
Name:DENIS T. C. CHAN M.D. INC
Entity type:Organization
Organization Name:DENIS T. C. CHAN M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:TSIN CHUNG
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-671-7155
Mailing Address - Street 1:94-748 B. HIKIMOE ST.
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-671-7155
Mailing Address - Fax:808-671-7155
Practice Address - Street 1:94-748 B. HIKIMOE ST.
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-671-7155
Practice Address - Fax:808-671-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000034371Medicaid
HI000034371Medicaid