Jack Wen Duo Chan-Imai, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 41586 Issued in CA

Practice address

4341 Piedmont Ave Ste 201
Oakland, CA 94611-4792

Phone

(510) 547-1630

NPI assigned

Sep 17, 2014

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 CA

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 and National Provider Directory roles.

• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment NPD

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1295137669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21015 PATHFINDER RD STE 100",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654002",
            "telephone_number": "909-861-3511",
            "fax_number": "909-860-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4341 PIEDMONT AVE STE 201",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946114792",
            "telephone_number": "510-547-1630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21015 Pathfinder Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Diamond Bar",
            "state": "CA",
            "postal_code": "917654002",
            "country_code": "US",
            "telephone_number": "909-861-3511 x305",
            "fax_number": "909-860-7900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN-IMAI",
        "first_name": "JACK",
        "middle_name": "WEN DUO",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-17",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 41586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Ann Chambre, MFT
• Andrew Jennati Champion
• Minh-Tran Champlin, PSY.D., LCSW
• Amandalyn Guarin Rapues Chan Kuo
• Siew Chan Werner, MD
• Alanna Chan, R.D., M.S.
• Antonette Ebro Chan
• April Sze-Yin Chan
• Barbara Chan, PT
• Clayton Chan, MD

• Physical Therapist in Oakland, CA
• Providers in Oakland, 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 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.