Sandia Plastic Surgery, PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

MD2007-0451 Issued in NM

Legal business name

SANDIA PLASTIC SURGERY, PC

Practice address

801 Encino Place NE
Suite D7
Albuquerque, NM 87102

Phone

(505) 842-0066

Fax

(505) 842-9325

NPI assigned

Apr 1, 2010

Last updated

Apr 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer W.H. Chan, M.D.

Title

Owner/Sole Member

Phone

(505) 842-0066

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429056000000",
    "number": "1407171408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ENCINO PLACE NE",
            "address_2": "SUITE D7",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87102",
            "telephone_number": "505-842-0066",
            "fax_number": "505-842-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 ENCINO PLACE NE",
            "address_2": "SUITE D7",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87102",
            "telephone_number": "505-842-0066",
            "fax_number": "505-842-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDIA PLASTIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-01",
        "last_updated": "2015-04-15",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "W.H.",
        "authorized_official_title_or_position": "OWNER/SOLE MEMBER",
        "authorized_official_telephone_number": "505-842-0066",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NM",
            "license": "MD2007-0451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Plastic Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; 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.