Provider Demographics
NPI:1124436134
Name:CHAN, KING CHONG (DMD, MS, FRCD(C))
Entity type:Individual
Prefix:DR
First Name:KING CHONG
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:DMD, MS, FRCD(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 24TH ST RM 837S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4020
Mailing Address - Country:US
Mailing Address - Phone:212-992-7081
Mailing Address - Fax:
Practice Address - Street 1:345 E 24TH ST RM 837S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-992-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCHANK21223P0106X
NY056437-11223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology