Provider Demographics
NPI:1275722902
Name:CHAN, KENNY K
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:K
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KENNY
Other - Middle Name:K
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:201 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3910
Mailing Address - Country:US
Mailing Address - Phone:415-487-3719
Mailing Address - Fax:415-487-3729
Practice Address - Street 1:201 8TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3910
Practice Address - Country:US
Practice Address - Phone:415-487-3719
Practice Address - Fax:415-487-3729
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health