Organization Active NPI

Edwin K Chan MD PC

  • Specialist
  • Flushing, NY
National Provider Identifier
1710113949
Registry record updated Oct 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
222486 Issued in NY
Legal business name
EDWIN K CHAN MD PC
Practice address
13640 39TH Ave
Ste 6GB
Flushing, NY 11354-5536
Phone
(718) 321-8246
Fax
(718) 321-8273
NPI assigned
Jun 2, 2009
Last updated
Oct 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2015

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

Authorized official

Name
Ms. Emily Lam
Title
Billing
Phone
(718) 321-8246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 222486 NY Primary

Addresses

Primary practice location

13640 39TH Ave
Ste 6GB
Flushing, NY 11354-5536

Mailing address

PO Box 2625
New York, NY 10009-8925
Phone (718) 321-8246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090828000063 NY Part B Supplier - Clinic/Group Practice 1951456847 Receives reassigned benefits from 6 practitioners
Practice locations: Flushing, NY

National Provider Directory

National Provider Directory

Locations

13640 39th Ave
#6
Flushing, NY 11354
Phone (718) 321-8246

13640 39th Ave
Ste 6GB
Flushing, NY 11354
Phone (718) 321-8246

1430 2nd Ave
Rm 110
New York, NY 10021
Phone (212) 535-2298

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBCDBA

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445212800000",
    "number": "1710113949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2625",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100098925",
            "telephone_number": "718-321-8246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13640 39TH AVE",
            "address_2": "STE 6GB",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545536",
            "telephone_number": "718-321-8246",
            "fax_number": "718-321-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWIN K CHAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-02",
        "last_updated": "2015-10-19",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "718-321-8246",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "222486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.