Healthcare Provider Details

I. General information

NPI: 1649236480
Provider Name (Legal Business Name): KENNETH KAI HEI CHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 400
LONG BEACH CA
90806-1553
US

IV. Provider business mailing address

23441 MADISON ST #290
TORRANCE CA
90505-4725
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-8510
  • Fax:
Mailing address:
  • Phone: 310-375-7172
  • Fax: 310-375-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG70376
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG70376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: