Healthcare Provider Details

I. General information

NPI: 1942117734
Provider Name (Legal Business Name): KAI TAI CHAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 N 35TH ST
MILWAUKEE WI
53208-2315
US

IV. Provider business mailing address

1535 N 35TH ST
MILWAUKEE WI
53208-2315
US

V. Phone/Fax

Practice location:
  • Phone: 414-934-4606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001025591
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: