Basic Information
| Provider Information | |||||||||
| NPI: | 1649236480 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | KAI HEI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23441 MADISON ST | ||||||||
| Address2: | #290 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905054725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103757172 | ||||||||
| FaxNumber: | 3103757192 | ||||||||
| Practice Location | |||||||||
| Address1: | 2888 LONG BEACH BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908061553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629978510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G70376 | CA | N | Other Service Providers | Specialist | 207VM0101X | G70376 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No ID Information.