Kenneth Kin Kan Chan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

125065913 Issued in IL

Practice address

2160 S. First Avenue
Loyola Outpatient Center, 4300
Maywood, IL 60153

Phone

(708) 216-6006

Fax

(708) 216-2683

NPI assigned

Apr 7, 2014

Last updated

Sep 26, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Loyola University Medical Center

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1528488897
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411689600000",
    "number": "1124446117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S. FIRST AVENUE",
            "address_2": "LOYOLA OUTPATIENT CENTER, 4300",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-6006",
            "fax_number": "708-216-2683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S. FIRST AVENUE",
            "address_2": "LOYOLA OUTPATIENT CENTER, 4300",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-216-6006",
            "fax_number": "708-216-2683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "KENNETH",
        "middle_name": "KIN KAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125065913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meenakshi Chaku, M.D.
• Malliswari Challapalli, MD
• Antonio D Champion, PH.D., LCSW
• Dennis Chan, MD
• Kelley Chan
• Kim Hoe Chan, MD
• Lucas Chan, M.D.
• William Chan
• Arcot J. Chandrasekhar, M.D.
• Michael Chanen, MD

• Family Medicine Physician in Maywood, IL
• Providers in Maywood, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.