Kelly Chenkai Fan, M. D.
Individual provider Active NPI Pulmonary Disease Physician · La Jolla, CA
NPI 1366889883 · NPPES record last updated Feb 15, 2022
Key facts
- NPI
- 1366889883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- A133109 (CA)
- Practice address
- 10666 N Torrey Pines Rd
La Jolla, CA 92037-1027 - Phone
- (858) 554-8860
- NPI assigned
- May 23, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Pulmonary Disease
- Education
- University of California, San Diego School of Medicine, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Scripps Health
Practice addresses (Care Compare)
10666 N Torrey Pines Rd
2ND Floor Sw209
La Jolla, CA 92037-1027
Phone (858) 554-8122
Hospital & facility affiliations
- Scripps Green Hospital
- Scripps Memorial Hospital la Jolla
- Scripps Memorial Hospital - Encinitas
- Scripps Mercy Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170727000372 | CA | Practitioner - Pulmonary Disease |
5395015168 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A133109 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients | |
| Scripps Health | Current | Accepting new patients | |
| Scripps Health Inpatient Providers Medical Group Inc. | Critical Care Medicine | Current | Accepting new patients |
| Scripps Health | Internal Medicine | Current |
Accepting new patients |
| Scripps Health | Internal Medicine | Current | Accepting new patients |
| Scripps Health | Current |
Accepting new patients | |
| Scripps Health | Current | Accepting new patients | |
| Scripps Health | Current | Accepting new patients | |
| Scripps Health | Past | Accepting new patients | |
| Scripps Clinic Medical Group | Past | Accepting new patients |
Locations
9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123
10666 N Torrey Pines Rd
Fl 2
La Jolla, CA 92037
Phone (858) 554-8122
10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626
File 54433
Los Angeles, CA 90074
Phone (858) 784-5645
10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626
Interoperability endpoints
- kfan33385@scrippshlth.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | A133109 | CA | |
| Pulmonary Disease Physician | 207RP1001X | A133109 | CA | Yes |
| Internal Medicine Physician | 207R00000X | A133109 | CA | |
| Critical Care Medicine (Internal Medicine) Physician | 207RC0200X | A133109 | CA |
Addresses
Primary practice location
10666 N Torrey Pines Rd
La Jolla, CA 92037-1027
Mailing address
10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 554-8860
NPI Registry JSON
{
"created_epoch": "1369267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1366889883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10790 RANCHO BERNARDO RD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921275705",
"telephone_number": "858-554-8860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10666 N TORREY PINES RD",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371027",
"telephone_number": "858-554-8860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "KELLY",
"middle_name": "CHENKAI",
"name_prefix": "Dr.",
"credential": "M. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-23",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "CA",
"license": "A133109",
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "CA",
"license": "A133109",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A133109",
"primary": false
},
{
"code": "207RC0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Critical Care Medicine",
"state": "CA",
"license": "A133109",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
- Arij Faksh
- Monsita Josefa Faley
- Joshua Paul Fallentine
- Lakeisha Nacoste Falwell
- Family First Home Care
- Holly K Fanning
- Halimo Shukri Yusuf Farah
- Lamis Elkhalil Farah
- Kayla Yasmin Farahbod
- Amir Faraji
All providers in La Jolla, CA · Pulmonary Disease Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.