Dora Chan, PHARMD, NUTRITIONIST

Primary specialty

NutritionistTaxonomy code 133N00000X

Practice address

8781 Paradise Valley Blvd
Lucerne, CA 95458-8549

Phone

(408) 802-2068

NPI assigned

May 4, 2021

Last updated

May 4, 2021By the provider in NPPES

Sex

Female

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

Credentials

Doctor of Pharmacy

Practice roles

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.

• Malla Ventures, Inc.

  • Nutritionist
  • Jersey City, NJ
  • NPI 1144114729
  NPD (past)

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

{
    "created_epoch": "1620086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1326621533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8781 PARADISE VALLEY BLVD",
            "city": "LUCERNE",
            "state": "CA",
            "postal_code": "954588549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8781 PARADISE VALLEY BLVD",
            "city": "LUCERNE",
            "state": "CA",
            "postal_code": "954588549",
            "telephone_number": "408-802-2068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "DORA",
        "credential": "PHARMD, NUTRITIONIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-04",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denyel Braley
• Lynn Brookes, NP
• Daisy Cabrera-Lugo
• Lori Carter-Runyon, CASII, CSC, NCACI,
• Luis Cedano, RADT-1
• Chin-Lung Chen, M.D.
• Maureen Conway
• Kelli Cosman
• County of Lake (Lake County Behavioral Health Services)
• County of Lake (Lake County Behavioral Health Services)

• Nutritionist in Lucerne, CA
• Providers in Lucerne, CA by specialty
• Nutritionist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; 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.