Provider Demographics
NPI:1063413714
Name:CHAN, KWOK L (MD)
Entity type:Individual
Prefix:DR
First Name:KWOK
Middle Name:L
Last Name:CHAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1013
Mailing Address - Country:US
Mailing Address - Phone:415-752-0337
Mailing Address - Fax:415-752-0260
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1013
Practice Address - Country:US
Practice Address - Phone:415-752-0337
Practice Address - Fax:415-752-0260
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-06-29
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Provider Licenses
StateLicense IDTaxonomies
CAG29657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44100Medicare UPIN