Basic Information
| Provider Information | |||||||||
| NPI: | 1629278817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | CHUN | ||||||||
| MiddleName: | WAI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LOTHROP ST | ||||||||
| Address2: | ROOM 9055 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128028271 | ||||||||
| FaxNumber: | 4126474486 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 CENTRE AVENUE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126232287 | ||||||||
| FaxNumber: | 4126236629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 07/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD430154 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.