Healthcare Provider Details

I. General information

NPI: 1063640977
Provider Name (Legal Business Name): DR KEVIN CHAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 S WARNER ELLIOT LOOP STE 1
PHOENIX AZ
85044-2731
US

IV. Provider business mailing address

12010 S WARNER ELLIOT LOOP STE 1
PHOENIX AZ
85044-2731
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2366
  • Fax: 480-961-2367
Mailing address:
  • Phone: 480-961-2366
  • Fax: 480-961-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN YIN SHUN CHAN
Title or Position: OWNER
Credential: DO
Phone: 480-577-8199