Provider Demographics
NPI:1649485061
Name:CHAN, YAN PUI (DDS)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:PUI
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 BETHEL ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2209
Mailing Address - Country:US
Mailing Address - Phone:808-521-7392
Mailing Address - Fax:808-521-7392
Practice Address - Street 1:1109 BETHEL ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2209
Practice Address - Country:US
Practice Address - Phone:808-521-7392
Practice Address - Fax:808-521-7392
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HID13561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02025001Medicaid