Active NPI
Derek Chan
- Dentist
- Nellis Afb, NV
National Provider Identifier
1023959400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8466
- Practice address
- 4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600 - Phone
- (702) 653-2273
- NPI assigned
- Apr 2, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8466 | NV | Primary |
Addresses
Primary practice location
4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Mailing address
4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600
Phone (702) 653-2273
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786320000000",
"number": "1023959400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 LAS VEGAS BLVD N",
"city": "NELLIS AFB",
"state": "NV",
"postal_code": "891916600",
"telephone_number": "702-653-2273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4700 LAS VEGAS BLVD N",
"city": "NELLIS AFB",
"state": "NV",
"postal_code": "891916600",
"telephone_number": "702-653-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "DEREK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-04-02",
"last_updated": "2026-08-10",
"certification_date": "2026-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "8466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nellis Afb, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.