Provider Demographics
NPI:1902986771
Name:CHAN, ANDREW HING KIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HING KIN
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ELIZABETH ST
Mailing Address - Street 2:RM# 502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-431-9884
Mailing Address - Fax:
Practice Address - Street 1:17 ELIZABETH ST
Practice Address - Street 2:RM# 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-431-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178285208D00000X, 208000000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01130827Medicaid
B95308Medicare UPIN
17F351Medicare ID - Type Unspecified