Provider Demographics
NPI:1336734292
Name:CHAN, KA KEUNG (PHD)
Entity Type:Individual
Prefix:
First Name:KA KEUNG
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVENUE
Mailing Address - Street 2:BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-4135
Mailing Address - Fax:585-273-3637
Practice Address - Street 1:211 BAILEY ROAD
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586
Practice Address - Country:US
Practice Address - Phone:585-275-8546
Practice Address - Fax:585-272-0008
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician