DR. KEITH TED CHAN MD NPI 1295001972

NPI Information

NPI: 1295001972
Provider Name: DR. KEITH TED CHAN, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Organization: VANTAGE RADIOLOGY AND DIAGNOSTIC SERVICES, A PROFESSIONAL SERVICES COR

PECOS Registration: Yes

Address:
1304 FAWCETT AVE STE 100
TACOMA, WA
ZIP 98402
Phone: (253) 761-4200
Get Directions

DR. Keith Ted Chan, MD is a diagnostic radiology radiology in Tacoma, WA with 13 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. DR. Keith Ted Chan, MD NPI is 1295001972. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: STANFORD UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2011

The provider's business location address is:

1304 FAWCETT AVE STE 100
TACOMA, WA
ZIP 98402-900
Phone: (253) 761-4200
Fax: (253) 761-4201

The NPI 1295001972 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/28/2012 and was last updated on 10/15/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	ML 60286792	WASHINGTON	No
2	2085R0204X	Radiology	Vascular & Interventional Radiology	MD60384220	WASHINGTON	No
3	2085R0202X	Radiology	Diagnostic Radiology	MD60384220	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2019235	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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