Individual ProviderTak ChanInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address13338 41st Rd, Ste 2c, Flushing, NY 11355-3661(718) 445-7788PECOS EnrollmentBased on the most recent information from CMS, provider Tak Chan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1265437842Provider TypeIndividualFull NameChan, TakTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date6/20/2005Last Updated12/14/2012Contact InformationPractice LocationPractice Address13338 41st Rd, Ste 2c, Flushing, NY 11355-3661Phone(718) 445-7788Fax(718) 445-7789Mailing LocationMailing Address13338 41st Rd, Suite 2c, Flushing, NY 11355-3661Phone(718) 445-7788Fax(718) 445-7789Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense204551New YorkProvider IdentifiersIDDescriptionIssuerID01888839DescriptionMedicaidIssuerUnlistedNew York