Basic Information
| Provider Information | |||||||||
| NPI: | 1588617914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | HO-SEE | ||||||||
| MiddleName: | CATHERINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 200 JEFFERSON AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166851805 | ||||||||
| FaxNumber: | 6166851850 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 JEFFERSON AVE SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166851805 | ||||||||
| FaxNumber: | 6166851850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301074568 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4599214 | 05 | MI | MEDICAID | 4599241 | 05 | MI | MEDICAID | 4599260 | 05 | MI | MEDICAID | 4599297 | 05 | MI | MEDICAID | 4877634 | 05 | MI | MEDICAID | 4578386 | 05 | MI | MEDICAID | 4599152 | 05 | MI | MEDICAID | 4599161 | 05 | MI | MEDICAID | 4599303 | 05 | MI | MEDICAID | 4584955 | 05 | MI | MEDICAID | 4593220 | 05 | MI | MEDICAID | 4599288 | 05 | MI | MEDICAID | 4877142 | 05 | MI | MEDICAID | 4599170 | 05 | MI | MEDICAID | 4599199 | 05 | MI | MEDICAID | 4889107 | 05 | MI | MEDICAID |