Individual provider Active NPI

Michael H. Chan

  • Oral and Maxillofacial Surgery (Dentist)
  • Brooklyn, NY
National Provider Identifier
1093769317
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
045149 Issued in NY
Practice address
800 Poly PL
Brooklyn, NY 11209-7104
Phone
(718) 630-3651
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 045149 NY Primary

Addresses

Primary practice location

800 Poly PL
Brooklyn, NY 11209-7104

Mailing address

161 W 61St St
New York, NY 10023-7462

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251010001360 NY Practitioner - Dentist 8022515428 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
Other, 1993
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

121 Dekalb Ave
Brooklyn, NY 11201-5493

PO Box
Suite 2000
East Syracuse, NY 13057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
045149NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
TBHC Physician Services PC CurrentSince Aug 1, 2025 Accepting new patients

Locations

155 Ashland Pl
Brooklyn, NY 11201
Phone (718) 250-8963

121 DeKalb Ave
Brooklyn, NY 11201
Phone (718) 250-6604

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1093769317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 W 61ST ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100237462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 POLY PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112097104",
            "telephone_number": "718-630-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "MICHAEL",
        "middle_name": "H.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "045149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.