J. Jack Chan, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

34005890 Issued in OH

Practice address

86 Columbus Rd
Ste 203
Athens, OH 45701-1331

Phone

(740) 594-2624

Fax

(740) 594-7333

NPI assigned

May 23, 2005

Last updated

May 19, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242691200000",
    "number": "1053314245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 COLUMBUS RD",
            "address_2": "SUITE 203",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457011300",
            "telephone_number": "740-594-2624",
            "fax_number": "740-594-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 COLUMBUS RD",
            "address_2": "STE 203",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457011331",
            "telephone_number": "740-594-2624",
            "fax_number": "740-594-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "J.",
        "middle_name": "JACK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2009-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "34005890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0956881",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Betty Chalfant
• Elizabeth Chamberlain
• Kristin Chamberlain, LPCC
• Mandy Champion, SWT
• Marie D Champion, CMA
• Yer Chang, D.O.
• Emma Chapman, RES SPEC
• Mychaela Chapman, LSW
• Sheena Charlton
• Joshua A Chavez

• Obstetrics & Gynecology Physician in Athens, OH
• Providers in Athens, OH by specialty
• Obstetrics & Gynecology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.