Provider Demographics
NPI:1891759510
Name:CHAN, KAM W (MD)
Entity Type:Individual
Prefix:
First Name:KAM
Middle Name:W
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1401 SAM RITTENBERG BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5031
Mailing Address - Country:US
Mailing Address - Phone:843-973-5393
Mailing Address - Fax:833-994-1098
Practice Address - Street 1:1401 SAM RITTENBERG BLVD STE 6
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5031
Practice Address - Country:US
Practice Address - Phone:843-973-5393
Practice Address - Fax:833-994-1098
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC21455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL32196Medicaid