Active NPI
Kenneth Kian-Lip Chan, MSPA PAC
- Physician Assistant
- New Brunswick, NJ
National Provider Identifier
1336306083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00098600
- Practice address
- 11 Bishop Place
Occupational Health Dept B3
New Brunswick, NJ 08901 - Phone
- (732) 932-8254
- Fax
- (732) 932-8254
- NPI assigned
- May 20, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 25MP00098600 | NJ | Primary |
Addresses
Primary practice location
11 Bishop Place
Occupational Health Dept B3
New Brunswick, NJ 08901
Mailing address
11 Bishop Place
Occupational Health Dept B3
New Brunswick, NJ 08901
Phone (732) 932-8254
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00098600 | NJ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1336306083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 BISHOP PLACE",
"address_2": "OCCUPATIONAL HEALTH DEPT B3",
"city": "NEW BRUNSWICK",
"state": "NJ",
"postal_code": "08901",
"telephone_number": "732-932-8254",
"fax_number": "732-932-8254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 BISHOP PLACE",
"address_2": "OCCUPATIONAL HEALTH DEPT B3",
"city": "NEW BRUNSWICK",
"state": "NJ",
"postal_code": "08901",
"telephone_number": "732-932-8254",
"fax_number": "732-932-8254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "KENNETH",
"middle_name": "KIAN-LIP",
"name_prefix": "Mr.",
"credential": "MSPA PAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-20",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00098600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.