Healthcare Provider Details

I. General information

NPI: 1669663886
Provider Name (Legal Business Name): QUINN KIN-WUNG CHAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 LINCOLN RD STE 1
LINCOLN MA
01773
US

IV. Provider business mailing address

152 LINCOLN RD STE 1
LINCOLN MA
01773-3832
US

V. Phone/Fax

Practice location:
  • Phone: 781-728-5455
  • Fax:
Mailing address:
  • Phone: 781-728-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901020574
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number03949
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN1855932
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: