Active NPI
Kin-Chung Chan, MD
- Neurology Physician
- Merced, CA
National Provider Identifier
1639284904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- A38749
- Practice address
- 315 Mercy Ave
Suite 400
Merced, CA 95340-8368 - Phone
- (209) 564-3700
- Fax
- (209) 564-3799
- NPI assigned
- Aug 20, 2006
- Last updated
- Mar 24, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | A38749 | CA | Primary |
Addresses
Primary practice location
315 Mercy Ave
Suite 400
Merced, CA 95340-8368
Mailing address
3400 Data Dr
Physician Support Services - 2ND Floor
Rancho Cordova, CA 95670-7956
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A387490 | Medicaid | CA |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A38749 | CA | MD | Neurology Physician |
| 38749 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395619200000",
"number": "1639284904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 DATA DR",
"address_2": "PHYSICIAN SUPPORT SERVICES - 2ND FLOOR",
"city": "RANCHO CORDOVA",
"state": "CA",
"postal_code": "956707956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 MERCY AVE",
"address_2": "SUITE 400",
"city": "MERCED",
"state": "CA",
"postal_code": "953408368",
"telephone_number": "209-564-3700",
"fax_number": "209-564-3799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "KIN-CHUNG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2014-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "A38749",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A387490",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Merced, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.