Provider Demographics
NPI:1811911837
Name:CHAN, SIU MING ALAIN (APRN, BC)
Entity type:Individual
Prefix:MR
First Name:SIU MING ALAIN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 HAWAII KAI DR
Mailing Address - Street 2:APT 407
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1567
Mailing Address - Country:US
Mailing Address - Phone:415-481-8147
Mailing Address - Fax:
Practice Address - Street 1:6770 HAWAII KAI DR
Practice Address - Street 2:APT 407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1567
Practice Address - Country:US
Practice Address - Phone:415-481-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-826363LF0000X
CA17588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI582793Medicaid
HI582793Medicaid
HI101962Medicare PIN