Ivan Chan

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

107682 Issued in CA

Practice address

435 Arden Ave Ste 570
Glendale, CA 91203-1143

Phone

(916) 690-1508

NPI assigned

Jul 30, 2022

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1659139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1306572359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6704 ESKRIDGE WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957586361",
            "telephone_number": "916-690-1508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 ARDEN AVE STE 570",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912031143",
            "telephone_number": "916-690-1508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-30",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raffi A Chalian, MD
• Champion Physical Therapy, Inc.
• Calvin Chan
• Choa Chan, M.D.
• Chun P. Chan, PT, DPT, LAC.
• Jessie Chan
• Shirley M Chan
• Tiffany Hope Chan, OD
• Virginia Irene Chan, MD
• Winnie Chan

• General Practice Dentistry in Glendale, CA
• Providers in Glendale, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.