MEDICARE: DR. EDWIN KENNETH CHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	222486	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982664611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN KENNETH CHAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2625
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-8925
Country	:	US
Telephone Number	:	718-321-8246
Fax Number	:	718-321-8273

Provider Business Practice Location Address
First Line	:	13640 39TH AVE
Second Line	:	SUITE 6GB
City	:	FLUSHING
State	:	NY
Zip	:	11354-5536
Country	:	US
Telephone Number	:	718-321-8246
Fax Number	:	718-321-8273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	02/18/2016

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