Individual provider Active NPI

Marie Grace Jimenez Dangalan, CPED, CFO, CTO

  • Pedorthist
  • Chicago, IL
National Provider Identifier
1104722305
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PedorthistTaxonomy code 224L00000X
License
CPED4548 Issued in IL
Practice address
820 S Damen Ave
Chicago, IL 60612-3728
Phone
(224) 713-6485
NPI assigned
Oct 15, 2026
Last updated
Oct 15, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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.

Verify at the official NPI Registry.