Individual
MR. KYLE CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
2510 30TH AVE, LONG ISLAND CITY, NY 11102-2448
(718) 267-4390
Mailing address
3 SUNNYFIELD RD, HICKSVILLE, NY 11801-4822
(516) 932-8584
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
005143
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2165320
—
NY
Enumeration date
06/28/2006
Last updated
07/08/2007
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