Provider Demographics
NPI:1609577618
Name:CHAN, KINA YAMNAR (NP)
Entity type:Individual
Prefix:
First Name:KINA
Middle Name:YAMNAR
Last Name:CHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E SCRANTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1326
Mailing Address - Country:US
Mailing Address - Phone:917-742-2822
Mailing Address - Fax:
Practice Address - Street 1:5718 2ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3313
Practice Address - Country:US
Practice Address - Phone:646-754-8531
Practice Address - Fax:646-754-8501
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310873-01363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty