Healthcare Provider Details

I. General information

NPI: 1982652517
Provider Name (Legal Business Name): GREGORY KWOK-KAY CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MINOR AVE
SEATTLE WA
98104
US

IV. Provider business mailing address

PO BOX 3489
SEATTLE WA
98114-3489
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-9500
  • Fax: 206-386-9605
Mailing address:
  • Phone: 206-386-9500
  • Fax: 206-386-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00012049
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD00012049
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: