Provider Demographics
NPI:1841547320
Name:CHAN, KEI (DDS)
Entity type:Individual
Prefix:DR
First Name:KEI
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 WEST 12TH STREET
Mailing Address - Street 2:SUITE 1 AB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014
Mailing Address - Country:US
Mailing Address - Phone:646-643-6099
Mailing Address - Fax:
Practice Address - Street 1:299 W 12TH ST
Practice Address - Street 2:SUITE 1 AB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1801
Practice Address - Country:US
Practice Address - Phone:646-643-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist