Active NPI
Marie Grace Jimenez Dangalan, CPED, CFO, CTO
- Pedorthist
- Chicago, IL
National Provider Identifier
1104722305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pedorthist
- License
- CPED4548
- Practice address
- 820 S Damen Ave
Chicago, IL 60612-3728 - Phone
- (224) 713-6485
- NPI assigned
- Oct 15, 2026
- Last updated
- Oct 15, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | CFO04547 | IL | |
| Pedorthist | 224L00000X | CPED4548 | IL | Primary |
Addresses
Primary practice location
820 S Damen Ave
Chicago, IL 60612-3728
Mailing address
820 S. Damen Avenue
Ogden Building 3Rd Floor
Chicago, IL 60612
Phone (224) 713-6485
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1792022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1792022400000",
"number": "1104722305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 S. DAMEN AVENUE",
"address_2": "OGDEN BUILDING 3RD FLOOR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "224-713-6485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 S DAMEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123728",
"telephone_number": "224-713-6485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANGALAN",
"first_name": "MARIE GRACE",
"middle_name": "JIMENEZ",
"credential": "CPED, CFO, CTO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-10-15",
"last_updated": "2026-10-15",
"certification_date": "2026-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": "IL",
"license": "CFO04547",
"primary": false
},
{
"code": "224L00000X",
"taxonomy_group": "",
"desc": "Pedorthist",
"state": "IL",
"license": "CPED4548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.