Kim, Samuel Chan

Kim, Samuel Chan is an individual health care provider with primary practice located at 5165 Mccarty Ln , Lafayette IN 47905-8764. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Kim, Samuel Chan can be contacted via phone (765) 448-8000.

Contact Information

Primary practice address
5165 Mccarty Ln Lafayette IN 47905-8764
Phone: (765) 448-8000
Fax: (765) 448-7619
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 01058979A Indiana

Profile Details

NPI number 1134129679
LBN Legal business name Kim, Samuel Chan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2005
Last updated Aug 11th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134129679 NPPES
Indiana Other 815500539 MEDICARE PTAN
Indiana MEDICAID 200476300A MEDICARE PTAN

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