Active NPI
Waiyin Chan, D.M.D.
- Pediatric Dentistry
- San Diego, CA
National Provider Identifier
1134410244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 62215
- Practice address
- 11360 Dalby PL
San Diego, CA 92126-1512 - Phone
- (858) 229-6927
- NPI assigned
- Apr 23, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatric Dentistry | 1223P0221X | 62215 | CA | Primary |
Addresses
Primary practice location
11360 Dalby PL
San Diego, CA 92126-1512
Mailing address
11360 Dalby PL
San Diego, CA 92126-1512
Phone (858) 229-6927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151005000476 | CA | Order and Referring Only - Dentist | 0446568893 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- wchan18336@syhealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373760000000",
"number": "1134410244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11360 DALBY PL",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921261512",
"telephone_number": "858-229-6927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11360 DALBY PL",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921261512",
"telephone_number": "858-229-6927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "WAIYIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-23",
"last_updated": "2013-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "62215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.