Healthcare Provider Details

I. General information

NPI: 1710273537
Provider Name (Legal Business Name): KANG NING CHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

1645 TULLIE CIR NE
ATLANTA GA
30329-2304
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6315
  • Fax:
Mailing address:
  • Phone: 404-785-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number274808
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number73537
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: