Provider Demographics
NPI:1174778351
Name:CHAN, YVONNE (LAC)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RAILROAD AVE
Mailing Address - Street 2:ROOM #206
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6301
Mailing Address - Country:US
Mailing Address - Phone:203-629-3800
Mailing Address - Fax:
Practice Address - Street 1:28 RAILROAD AVE
Practice Address - Street 2:ROOM #206
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6301
Practice Address - Country:US
Practice Address - Phone:203-629-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist