Provider Demographics
NPI:1528014248
Name:CHAN, KEVIN YIN SHUN (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:YIN SHUN
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:Y
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:12010 S WARNER ELLIOT LOOP
Mailing Address - Street 2:STE 1
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI25354Medicare UPIN