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DR. KELLY J CHAN MD
NPI 1053060277
Student in an Organized Health Care Education/Training Program in Sacramento, CA

Active since March 23, 2022PECOS Enrolled
4860 Y ST STE 3700, SACRAMENTO, CA 95817(916) 734-3588 Get Directions Write a Review

NPPES record last updated: March 23, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Kelly J Chan Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY J CHAN MD (NPI 1053060277) is an individual student in an organized health care education/training program in Sacramento, California and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053060277
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. KELLY J CHANCredential: MD
Location Address4860 Y ST STE 3700Sacramento, CA 95817-2307
Mailing Address4860 Y St Ste 3700Sacramento, CA 95817-2307 · (916) 734-3588
Phone(916) 734-3588
Sole ProprietorYes
Enumeration DateMarch 23, 2022
NPPES CertifiedMarch 23, 2022
✔ NPI 1053060277 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4860 Y ST STE 3700, Sacramento, CA 95817
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelly J Chan Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. THOMAS LE MD
Student in an Organized Health Care Education/Training Program
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 734-3588
DR. DAI PHUONG NGUYEN MD, MBA
Psychiatry & Neurology (Neurology)
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 734-3588
JOSHUA DAVIS
Student in an Organized Health Care Education/Training Program
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 734-3588
ANDREW SANTOS
Student in an Organized Health Care Education/Training Program
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 734-3588
DR. SIMRIT KAUR SODHI M.D.
Psychiatry & Neurology (Neurology)
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 734-3514
MICHELLE CHAN PH.D.
Clinical Neuropsychologist
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 703-5019
ALEJANDRA MARCELA MARQUEZ LOZA MD
Psychiatry & Neurology (Neurology)
4860 Y ST STE 3700
SACRAMENTO, CA 95817
Sacramento County (916) 734-6285
GREGORY Y CHANG MD
Psychiatry & Neurology (Neurology)
4860 Y ST STE 3700, UC DAVIS MEDICAL CENTER
SACRAMENTO, CA 95817
Sacramento County (916) 734-6280

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Chan's NPI number?

The NPI number for Kelly Chan is 1053060277. It was assigned to this individual provider in the NPPES registry on March 23, 2022.

Where is Kelly Chan located?

Kelly Chan practices at 4860 Y St Ste 3700, Sacramento, CA 95817. The listed phone number is (916) 734-3588.

What is Kelly Chan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Kelly Chan enrolled in Medicare?

Yes. Kelly Chan is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Chan was last updated on March 23, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.