Jackie Chan, ATC, DPT, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

301538 Issued in CA

Practice address

201 Sandpointe Ave Ste 130
Santa Ana, CA 92707-5785

Phone

(714) 557-9292

NPI assigned

Aug 6, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668297600000",
    "number": "1285066837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SANDPOINTE AVE STE 130",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927075785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SANDPOINTE AVE STE 130",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927075785",
            "telephone_number": "714-557-9292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1630 E BULLDOG LANE OF87",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937103834",
            "country_code": "US",
            "telephone_number": "559-278-4170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JACKIE",
        "credential": "ATC, DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-06",
        "last_updated": "2022-11-13",
        "certification_date": "2022-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "2000014495",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "301538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Chamorro, BEHAVIOR TECHNICIAN
• Camille Andrea Chamoun
• Brian Robert Champagne, MD
• Champion Medical Group, a Medical Corporation
• Alma Sinai Chamu
• Kevin Hin Lap Chan
• Samantha Sanh Chan, BSN, CCRN, MSN, FNP
• Chances Counseling Center
• Chances Counseling Centers LLC
• Lauren Rae Chandler, MSW, ACSW

• Physical Therapist in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.