Provider Demographics
NPI:1174144349
Name:CHAN, KEVIN SHE-WAI (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHE-WAI
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CATCH FLY LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2556
Mailing Address - Country:US
Mailing Address - Phone:214-608-6222
Mailing Address - Fax:
Practice Address - Street 1:4106 WAKE FOREST RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6397
Practice Address - Country:US
Practice Address - Phone:919-876-2464
Practice Address - Fax:919-876-1409
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
NC118511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program