Provider Demographics
NPI:1063640977
Name:DR KEVIN CHAN PC
Entity Type:Organization
Organization Name:DR KEVIN CHAN PC
Other - Org Name:PINEAPPLE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:YIN SHUN
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-577-8199
Mailing Address - Street 1:12010 S WARNER ELLIOT LOOP STE 1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-2731
Mailing Address - Country:US
Mailing Address - Phone:480-961-2366
Mailing Address - Fax:480-961-2367
Practice Address - Street 1:12010 S WARNER ELLIOT LOOP STE 1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2731
Practice Address - Country:US
Practice Address - Phone:480-961-2366
Practice Address - Fax:480-961-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty