Active NPI
Brian Pak Ho Chan, M.D.
- Student in an Organized Health Care Education/Training Program
- Boston, MA
National Provider Identifier
1194205237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- 277470
- Practice address
- 330 Brookline Avenue
Stoneman 458
Boston, MA 02215 - Phone
- (617) 667-2136
- Fax
- (617) 667-1728
- NPI assigned
- Aug 17, 2018
- Reactivated
- Apr 1, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 277470 | MA | Primary |
Addresses
Primary practice location
330 Brookline Avenue
Stoneman 458
Boston, MA 02215
Mailing address
330 Brookline Avenue
Stoneman 458
Boston, MA 02215
Phone (617) 667-2136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100258 | Other | CPSO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 277470 | MA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc | Past | Accepting new patients | |
| Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dermatology Physician
- Boston, MA
- NPI 1043250616
-
- Internal Medicine Physician
- Boston, MA
- NPI 1194765438
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554854400000",
"number": "1194205237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 BROOKLINE AVENUE",
"address_2": "STONEMAN 458",
"city": "BOSTON",
"state": "MA",
"postal_code": "02215",
"telephone_number": "617-667-2136",
"fax_number": "617-667-1728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 BROOKLINE AVENUE",
"address_2": "STONEMAN 458",
"city": "BOSTON",
"state": "MA",
"postal_code": "02215",
"telephone_number": "617-667-2136",
"fax_number": "617-667-1728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "BRIAN",
"middle_name": "PAK HO",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-17",
"last_updated": "2019-04-10",
"deactivation_date": "2019-03-25",
"reactivation_date": "2019-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": "277470",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CPSO",
"identifier": "100258",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.