Clifford Ray Chan, DMD, PHD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

34822 Issued in CA

Practice address

1600 E Florida Ave Ste 207
Hemet, CA 92544-8638

Phone

(951) 766-4354

Fax

(951) 766-4356

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184643876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E FLORIDA AVE STE 207",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925448638",
            "telephone_number": "951-766-4354",
            "fax_number": "951-766-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E FLORIDA AVE STE 207",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925448638",
            "telephone_number": "951-766-4354",
            "fax_number": "951-766-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CLIFFORD",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DMD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "34822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ceome LLC
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• Milan S Chakrabarty, M.D.
• Cathy A Chance, PH.D.
• Chanchai Karouna Optometry Inc.
• Lauren Chandler, DC
• Megan Irene Chaney, LCSW
• Kenneth C.S. Chang, M.D.

• Periodontics in Hemet, CA
• Providers in Hemet, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.