1336306083 NPI number — MR. KENNETH KIAN-LIP CHAN MSPA PAC

Table of content: MR. KENNETH KIAN-LIP CHAN MSPA PAC (NPI 1336306083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336306083 NPI number — MR. KENNETH KIAN-LIP CHAN MSPA PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAN
Provider First Name:
KENNETH
Provider Middle Name:
KIAN-LIP
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSPA PAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336306083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 BISHOP PLACE
Provider Second Line Business Mailing Address:
OCCUPATIONAL HEALTH DEPT B3
Provider Business Mailing Address City Name:
NEW BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-932-8254
Provider Business Mailing Address Fax Number:
732-932-8254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 BISHOP PLACE
Provider Second Line Business Practice Location Address:
OCCUPATIONAL HEALTH DEPT B3
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-932-8254
Provider Business Practice Location Address Fax Number:
732-932-8254
Provider Enumeration Date:
05/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  25MP00098600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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