Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | ME96781 | FL |
NPI | 1124103866 |
---|---|
Provider Name | Kak-Chen Chan |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-5423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022643400 | (05) | FL |
H10265 | (02) |