Individual provider Active NPI

Daniel Konchan

  • Physician Assistant
  • Corona del Mar, CA
National Provider Identifier
1356047542
Registry record updated Jul 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA62239 Issued in CA
Practice address
219 Marguerite Ave
Corona del Mar, CA 92625-3043
Phone
(949) 209-1563
Fax
(949) 539-8822
NPI assigned
Jan 31, 2023
Last updated
Jul 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA62239 CA Primary

Addresses

Primary practice location

219 Marguerite Ave
Corona del Mar, CA 92625-3043

Mailing address

219 Marguerite Ave
Corona del Mar, CA 92625-3043
Phone (949) 209-1563

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR, AZ, NV, CO, WA, CT, SC, OH, UT, MD, TN, KY13 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 13

Enrollment IDStateProvider typePAC IDDetails
I20230306001270 CA Practitioner - Physician Assistant 9931572302
I20240719003331 OR Practitioner - Physician Assistant 9931572302 Reassigns benefits to 2 organizations
I20240722003579 AZ Practitioner - Physician Assistant 9931572302 Reassigns benefits to 3 organizations
I20240925000663 NV Practitioner - Physician Assistant 9931572302 Reassigns benefits to 1 organization
I20250114003457 CO Practitioner - Physician Assistant 9931572302 Reassigns benefits to 1 organization
I20250127000278 WA Practitioner - Physician Assistant 9931572302 Reassigns benefits to 2 organizations
I20250918001631 CT Practitioner - Physician Assistant 9931572302
I20260115002504 SC Practitioner - Physician Assistant 9931572302 Reassigns benefits to 1 organization
I20260120002088 OH Practitioner - Physician Assistant 9931572302 Reassigns benefits to 1 organization
I20260128001163 UT Practitioner - Physician Assistant 9931572302 Reassigns benefits to 2 organizations
I20260218000188 MD Practitioner - Physician Assistant 9931572302 Reassigns benefits to 1 organization
I20260220000786 TN Practitioner - Physician Assistant 9931572302 Reassigns benefits to 2 organizations
I20260302003231 KY Practitioner - Physician Assistant 9931572302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
J M Geiss DO ApcGroup PAC ID 6103044078, 13 clinicians
Senior Doc Oregon PCGroup PAC ID 0749643716, 4 clinicians

Practice addresses (Care Compare)

Murfreesboro, TN 37129
Phone (855) 434-7763

Louisville, KY 40241
Phone (855) 434-7763

Ontario, OR 97914
Phone 8554347763402

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6014SCMDMassage Therapist
PA62239CAMDPhysician Assistant
6698TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Doc South Carolina PC CurrentSince Oct 3, 2025 Accepting new patients
Senior Doc, Tennessee PC CurrentSince Dec 7, 2025 Accepting new patients
Senior Doc Maryland PC CurrentSince Jan 5, 2026 Accepting new patients
Senior Doc Utah PC CurrentSince Dec 15, 2025 Accepting new patients
Deva Health, Corp. PastSince Jul 14, 2026 Accepting new patients

Locations

2592 N Santiago Blvd
Orange, CA 92867
Phone (714) 577-2271

5 Hutton Centre Dr
Ste 95
Santa Ana, CA 92707

5 Hutton Centre Dr
Ste 950
Santa Ana, CA 92707
Phone (855) 434-7663

6700 Alexander Bell Dr
Ste 200
Columbia, MD 21046
Phone (201) 581-3411

700 Nexton Square Dr
Ste 410
Summerville, SC 29486

2615 Medical Center Pkwy
Ste 1560
Murfreesboro, TN 37129
Phone (615) 525-6181

40 Burton Hills Blvd
Ste 200
Nashville, TN 37215
Phone (615) 257-8410

221 E 25th St
Ogden, UT 84401
Phone (623) 300-5477

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 11

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784592000000",
    "number": "1356047542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 MARGUERITE AVE",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926253043",
            "telephone_number": "949-209-1563",
            "fax_number": "949-539-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 MARGUERITE AVE",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926253043",
            "telephone_number": "949-209-1563",
            "fax_number": "949-539-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONCHAN",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-31",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA62239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona del Mar, CA

Sources for this page

Verify at the official NPI Registry.