Bryan Pui Wang Chan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A48504 Issued in CA

Practice address

980 E Foothill Blvd
Ste 104
Upland, CA 91786

Phone

(909) 920-3578

Fax

(909) 949-1238

NPI assigned

Sep 4, 2006

Last updated

Jun 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 1979

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Chino Medical Group, Inc

  dba My Family Medical Group

  • Health Maintenance Organization
  • Chino, CA
  • NPI 1790730786

  Family Medicine

  NPD (past)
• Prime Healthcare Services - Montclair, LLC

  dba Montclair Hopsital Medical Center

  • General Acute Care Hospital
  • Montclair, CA
  • NPI 1992721161
  NPD (past)
• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  NPD (past)
• Primecare Medical Group

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1093720427
  NPD (past)

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

• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  Care Compare affiliation

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

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1417059957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 E FOOTHILL BLVD",
            "address_2": "STE 104",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-920-3578",
            "fax_number": "909-949-1238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 E FOOTHILL BLVD",
            "address_2": "STE 104",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "91786",
            "telephone_number": "909-920-3578",
            "fax_number": "909-949-1238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "BRYAN",
        "middle_name": "PUI WANG",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-04",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC 7887",
            "primary": false
        },
        {
            "code": "175L00000X",
            "taxonomy_group": "",
            "desc": "Homeopath",
            "state": "NV",
            "license": "9007",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A48504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A485040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Cervantes, D.D.S.
• Rebecca Cervantez
• Michael Chai, M.D.
• Leslie Guadalupe Chaires
• Annie Chan, PHARMD
• Cecille Joy Rasgo Chan, PA-C
• Edwin C Chan, B.PHARM, MBA
• Fiona C Chan, DDS
• Larry C Chan, D.O.
• Megan Chan

• Family Medicine Physician in Upland, CA
• Providers in Upland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.