Provider Demographics
NPI:1730284308
Name:CHAN, CHUN-KIT (DO)
Entity Type:Individual
Prefix:DR
First Name:CHUN-KIT
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MOTT ST RM 305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5097
Mailing Address - Country:US
Mailing Address - Phone:212-791-6968
Mailing Address - Fax:212-791-6983
Practice Address - Street 1:2 MOTT ST RM 305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5097
Practice Address - Country:US
Practice Address - Phone:212-791-6968
Practice Address - Fax:212-791-6983
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02164905Medicaid
WANQ41OtherMEDICARE
NY02164905Medicaid