Healthcare Provider Details

I. General information

NPI: 1245165067
Provider Name (Legal Business Name): KAILI CHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 POST RD FL 2
FAIRFIELD CT
06824-6232
US

IV. Provider business mailing address

425 POST RD FL 2
FAIRFIELD CT
06824-6232
US

V. Phone/Fax

Practice location:
  • Phone: 203-292-9490
  • Fax: 203-292-9487
Mailing address:
  • Phone: 203-292-9490
  • Fax: 203-292-9487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7796
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: