Kyle Chan, P.A.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

005143 Issued in NY

Practice address

2510 30TH Ave
Long Island City, NY 11102-2448

Phone

(718) 267-4390

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Nassau Health Care Corporation

  • General Acute Care Hospital
  • East Meadow, NY
  • NPI 1902822992
  Medicare reassignment
• Nassau Health Care Corporation

  • General Acute Care Hospital
  • East Meadow, NY
  • NPI 1730530940
  NPD
• Nassau Health Care Corporation

  • General Acute Care Hospital
  • East Meadow, NY
  • NPI 1982620977
  NPD

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720016983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SUNNYFIELD RD",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014822",
            "telephone_number": "516-932-8584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 30TH AVE",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111022448",
            "telephone_number": "718-267-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "005143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2165320",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judy Cevallos, MA
• Fatematuz Zohara Chamak
• Kristeena Chambers
• Amy Chan, L.C.S.W.
• Jason Chan, FNP
• Melissa Chan
• Secion Chan, M.D.
• Valecia Chan, PA
• Wai Hung Steve Chan, MA OTR/L
• Sachin Chandragiri

• Medical Physician Assistant in Long Island City, NY
• Providers in Long Island City, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.