Marvin Chan

Primary specialty

DentistTaxonomy code 122300000X

License

30-023986 Issued in OH

Practice address

5064 Waterford Dr
Sheffield Village, OH 44035-1497

Phone

(440) 934-5966

NPI assigned

Jun 12, 2013

Last updated

Jan 24, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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 OH

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chan Dental LLC

  • Dental Clinic/Center
  • Seven Hills, OH
  • NPI 1477267417
  NPD Authorized official
• Chan Family Dental

  • Dental Clinic/Center
  • Sheffield Village, OH
  • NPI 1215689088
  NPD Authorized official
• Chan Family Dental Beachwood

  • Dental Clinic/Center
  • Beachwood, OH
  • NPI 1275443251
  NPD (past) Authorized official
• Lakireddy Dental LLC

  • General Practice Dentistry
  • Mentor, OH
  • NPI 1295005411
  NPD (past)

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1265870208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5064 WATERFORD DR",
            "city": "SHEFFIELD VILLAGE",
            "state": "OH",
            "postal_code": "440351497",
            "telephone_number": "440-934-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5064 WATERFORD DR",
            "city": "SHEFFIELD VILLAGE",
            "state": "OH",
            "postal_code": "440351497",
            "telephone_number": "440-934-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "MARVIN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-023986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Ann Carter, M.D.
• Patricia Casey
• Jerome M Cash
• Center for Orthopedics, Inc.
• Chan Family Dental
• Chiropractic Concepts Inc.
• Charles I Choi, MD
• Scott Martin Ciaccia, D.O.
• Cleveland Clinic Foundation (Cleveland Clinic Orthopaedics and Specialty Services)
• Cleveland Vamc

• Dentist in Sheffield Village, OH
• Providers in Sheffield Village, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; 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.