Provider Demographics
NPI:1538834007
Name:CHAN, JOANN K (DACM, LAC)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:K
Last Name:CHAN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PIKE ST APT 5G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7348
Mailing Address - Country:US
Mailing Address - Phone:917-790-9167
Mailing Address - Fax:
Practice Address - Street 1:186 MONTAGUE ST LBBY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3634
Practice Address - Country:US
Practice Address - Phone:917-790-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006581-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist