Provider Demographics
NPI:1124147012
Name:CHAN, KEITH C (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:SUITE 143
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-867-0404
Mailing Address - Fax:602-788-0893
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 143
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-867-0404
Practice Address - Fax:602-788-0893
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-01-21
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Provider Licenses
StateLicense IDTaxonomies
AZ367752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology