Healthcare Provider Details

I. General information

NPI: 1942138136
Provider Name (Legal Business Name): KELVIN J CHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 KINGS HWY
BROOKLYN NY
11229-1705
US

IV. Provider business mailing address

2525 KINGS HWY
BROOKLYN NY
11229-1705
US

V. Phone/Fax

Practice location:
  • Phone: 718-692-5300
  • Fax:
Mailing address:
  • Phone: 718-692-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035516
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: