Provider Demographics
NPI:1881770519
Name:CHAN, PAUL S (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007016261207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200436290EMedicaid
KS200436290FMedicaid
KS200436290COtherMEDICAID - CUSHING
KSP00842594OtherRAILROAD MEDICARE
MOP00842658OtherRAILROAD MEDICARE
MO207398603Medicaid
KSKA1021036OtherMEDICARE - CUSHING
KS200436290AMedicaid
KS200436290BMedicaid
KSKA1724006Medicare PIN
KSKA1021036OtherMEDICARE - CUSHING
KSP00842594OtherRAILROAD MEDICARE
KS200436290BMedicaid