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General NPI Number Information
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NPI Number | 1497468607
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Entity Type | Individual
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Provider Name | KENNY CHAN
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Gender | Male
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 13056 SE 76TH ST
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City | NEWCASTLE
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State | WA
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Zip | 98056-4159
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Country | US
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Telephone | 425-386-3833
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Fax |
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Provider Business Mailing Address
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Address Line | 12834 SE 41ST LN UNIT E101
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City | BELLEVUE
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State | WA
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Zip | 98006-1210
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Country | US
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Telephone | 206-214-6388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P1-60067333
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License Number State | WA
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