Provider Demographics
NPI:1942011838
Name:CHAN SHUM, KEVIN (DPT, PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:CHAN SHUM
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 TEMPLE CITY BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1765
Mailing Address - Country:US
Mailing Address - Phone:626-236-3537
Mailing Address - Fax:
Practice Address - Street 1:842 E VILLA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1259
Practice Address - Country:US
Practice Address - Phone:626-463-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist