Healthcare Provider Details

I. General information

NPI: 1639178460
Provider Name (Legal Business Name): KENNETH KWOK-CHUN CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANDOVER PEDIATRICS NPI 1548393176 203 TURNPIKE ST, SUITE 200
NORTH ANDOVER MA
01845
US

IV. Provider business mailing address

ANDOVER PEDIATRICS NPI 1548393176 203 TURNPIKE ST, SUITE 200
NORTH ANDOVER MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-4522
  • Fax: 978-475-6531
Mailing address:
  • Phone: 978-475-4522
  • Fax: 978-475-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number205542
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: