Provider Demographics
NPI:1174557979
Name:CHAN, YING (MD)
Entity type:Individual
Prefix:
First Name:YING
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YING
Other - Middle Name:
Other - Last Name:CHAN-MARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13336 41ST RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3666
Mailing Address - Country:US
Mailing Address - Phone:718-268-0008
Mailing Address - Fax:718-744-2608
Practice Address - Street 1:13336 41ST RD STE 2A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3666
Practice Address - Country:US
Practice Address - Phone:718-268-0008
Practice Address - Fax:347-851-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05936800207VM0101X
NY2068741261QH0100X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8422206Medicaid
NY08199783Medicaid