Provider Demographics
NPI:1871286724
Name:CHAN, CHRISTOPHER K (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:K
Last Name:CHAN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:K
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:150 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2508
Mailing Address - Country:US
Mailing Address - Phone:732-546-6029
Mailing Address - Fax:
Practice Address - Street 1:150 55TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-630-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist