NPIMap

Individual provider Active NPI

Kevin Yin Shun Chan, DO

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1528014248
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4101 Issued in AZ
Practice address
12010 S Warner Elliot Loop Ste 1
Phoenix, AZ 85044-2731
Phone
(480) 961-2366
Fax
(480) 961-2367
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4101 AZ Primary

Addresses

Primary practice location

12010 S Warner Elliot Loop Ste 1
Phoenix, AZ 85044-2731

Mailing address

12010 S Warner Elliot Loop
Ste 1
Phoenix, AZ 85044-2731
Phone (480) 961-2366

Other practice location 1

3196 N Windsong Dr
Prescott Valley, AZ 86314-2239
Phone (928) 772-1505

Other names 1

  • Kevin Y Chan Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050218000866 AZ Practitioner - Family PracticePractitioner - Preventive MedicinePractitioner - Osteopathic Manipulative Medicine 2769434562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12010 S Warner Elliot Loop
Suite 1
Phoenix, AZ 85044-2731
Phone (480) 961-2366

Hospital & facility affiliations

  • St Josephs Hospital and Medical Center Hospital, Phoenix, AZ, CCN 030024
  • Mercy Gilbert Medical Center Hospital, Gilbert, AZ, CCN 030119
  • Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012
  • Honor Health John C. Lincoln Medical Center Hospital, Phoenix, AZ, CCN 030014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Kevin Chan PC Family Medicine CurrentSince Jul 1, 2009 Accepting new patients
Iatriko, LLC Family Medicine Past Accepting new patients
Novus Healthcare Group, LLC Family Medicine Past Accepting new patients
Balance Multicare, PLC Past Accepting new patients
Prescott Valley Chiropractic LLC Past Accepting new patients
Richard a. Snider, MD, PC Past Accepting new patients

Locations

4530 E Ray Rd
Ste 172
Phoenix, AZ 85044
Phone (480) 759-9191

12010 S Warner Elliot Loop
Ste 1
Phoenix, AZ 85044
Phone (480) 961-2366

4545 E Chandler Blvd
Ste 104
Phoenix, AZ 85048
Phone (480) 728-4400

3196 N Windsong Dr
Prescott Vly, AZ 86314
Phone (928) 772-1505

Organizations & group practices 6

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1528014248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12010 S WARNER ELLIOT LOOP",
            "address_2": "STE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850442731",
            "telephone_number": "480-961-2366",
            "fax_number": "480-961-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12010 S WARNER ELLIOT LOOP STE 1",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850442731",
            "telephone_number": "480-961-2366",
            "fax_number": "480-961-2367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3196 N Windsong Dr",
            "address_purpose": "LOCATION",
            "city": "Prescott Valley",
            "state": "AZ",
            "postal_code": "863142239",
            "country_code": "US",
            "telephone_number": "928-772-1505",
            "fax_number": "928-772-6343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "KEVIN",
        "middle_name": "YIN SHUN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "4101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEVIN",
            "last_name": "CHAN",
            "middle_name": "Y",
            "credential": "DO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.