Individual provider Active NPI

Humphrey Chan, MD

  • Student in an Organized Health Care Education/Training Program
  • Los Angeles, CA
National Provider Identifier
1104715002
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1100 N State St
Los Angeles, CA 90033-5000
Phone
(323) 409-4535
NPI assigned
Jul 2, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1100 N State St
Los Angeles, CA 90033-5000

Mailing address

1100 N State St
Los Angeles, CA 90033-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1104715002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N STATE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N STATE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335000",
            "telephone_number": "323-409-4535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "HUMPHREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.