Active NPI
Kimberly Ming Chan, M.D.
- Surgery Physician
- Silverdale, WA
National Provider Identifier
1194896779
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Aug 20, 2013.
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD00046109
- Practice address
- 9800 Levin Rd NW
Suite 204
Silverdale, WA 98383-7856 - Phone
- (360) 613-1335
- Fax
- (360) 613-1329
- NPI assigned
- Nov 13, 2006
- Last updated
- Feb 3, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD00046109 | WA | Primary |
Addresses
Primary practice location
9800 Levin Rd NW
Suite 204
Silverdale, WA 98383-7856
Mailing address
9800 Levin Rd NW
Suite 204
Silverdale, WA 98383-7856
Phone (360) 613-1335
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kitsap General Surgery PLLC | Surgery | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IBADAA
Organizations & group practices 1
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.
-
- Surgery Physician
- Silverdale, WA
- NPI 1912010984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265155200000",
"number": "1194896779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9800 LEVIN RD NW",
"address_2": "SUITE 204",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "983837856",
"telephone_number": "360-613-1335",
"fax_number": "360-613-1329"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9800 LEVIN RD NW",
"address_2": "SUITE 204",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "983837856",
"telephone_number": "360-613-1335",
"fax_number": "360-613-1329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "KIMBERLY",
"middle_name": "MING",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2010-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WA",
"license": "MD00046109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Silverdale, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.