Provider Demographics
NPI:1821195736
Name:CHAN, CHONG KIT WILLIAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHONG KIT WILLIAM
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MAIN ST
Mailing Address - Street 2:STE 204
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1563
Mailing Address - Country:US
Mailing Address - Phone:781-331-7075
Mailing Address - Fax:781-740-8159
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:STE 204
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1563
Practice Address - Country:US
Practice Address - Phone:781-331-7075
Practice Address - Fax:781-740-8159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709117OtherTUFTS
MAY70845OtherBLUE CROSS BLUE SHIELD
MA64831OtherFALLON
MA0362719Medicaid
MA33136OtherHARVARD PILGRIM
MAT58793Medicare UPIN
MA709117OtherTUFTS