Provider Demographics
NPI:1356453815
Name:CHAN, KA KAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KA KAM
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1199 BUSH ST 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5975
Mailing Address - Country:US
Mailing Address - Phone:415-921-8210
Mailing Address - Fax:415-921-0387
Practice Address - Street 1:1199 BUSH ST 400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5975
Practice Address - Country:US
Practice Address - Phone:415-921-8210
Practice Address - Fax:415-921-0387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3248034OtherCCS/GHPP
CA110087983OtherMEDICARE RAILROAD
CA00A504470Medicaid
CA570674OtherCCHP
CA00A504470Medicaid
CA570674OtherCCHP