Provider Demographics
NPI:1912916263
Name:CHAN, LAWRENCE SIU-YUNG (MD, MHA)
Entity Type:Individual
Prefix:PROF
First Name:LAWRENCE
Middle Name:SIU-YUNG
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 C ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3367
Mailing Address - Country:US
Mailing Address - Phone:916-551-2608
Mailing Address - Fax:
Practice Address - Street 1:3301 C ST STE 1400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3367
Practice Address - Country:US
Practice Address - Phone:916-551-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085852207N00000X
CAG70528207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F42218Medicare UPIN
L91574Medicare ID - Type Unspecified