Keith Ming Chan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

120 Issued in GU

Practice address

241 Condo LN Apt 602
Tamuning, GU 96913-3144

Phone

(671) 864-4778

NPI assigned

Jan 22, 2009

Last updated

Jul 27, 2016By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Newgen Aesthetics & Wellness, LLC

  dba Newgen Home Health Agency

  • Home Health Agency
  • Tamuning, GU
  • NPI 1417623380

  Physical Therapist

  NPD

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469577600000",
    "number": "1376781799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 CONDO LN APT 602",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133144",
            "telephone_number": "671-864-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 CONDO LN APT 602",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133144",
            "telephone_number": "671-864-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "KEITH",
        "middle_name": "MING",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-22",
        "last_updated": "2016-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "35320",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GU",
            "license": "120",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "HI",
            "license": "3952",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Reyes Castro, M.D.
• Marleen Rose Cruz Castro, LCSW
• Troadio Buenaventura Castro, M.D.
• Elizabeth Q Cauley
• Center for Women's Health, LLC
• Young Chang, MD
• Jim Nan Chen, M.D.
• Ramsey Neal Chichakli, M.D.
• Alison Chong, FNP
• Dae-Eil Chong

• Physical Therapist in Tamuning, GU
• Providers in Tamuning, GU by specialty
• Physical Therapist in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2016; 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.