Provider Demographics
NPI:1952343014
Name:CHAN, CHEUNG HING (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHEUNG
Middle Name:HING
Last Name:CHAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1018
Mailing Address - Country:US
Mailing Address - Phone:773-238-7400
Mailing Address - Fax:312-225-0818
Practice Address - Street 1:2143 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1018
Practice Address - Country:US
Practice Address - Phone:773-238-7400
Practice Address - Fax:312-225-0818
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004337213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004337Medicaid
IL016004337Medicaid