Jimmy Chan, LCSW, LPHA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149012281 Issued in IL

Practice address

3062 E 91St St
Chicago, IL 60617-4401

Phone

(773) 371-2925

Fax

(773) 371-2950

NPI assigned

Dec 6, 2012

Last updated

Dec 6, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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)

Enrolled

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.

• Metropolitan Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1841460391
  NPD (past)
• Metropolitan Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1992767032
  NPD (past)

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1437494127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3062 E 91ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3062 E 91ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174401",
            "telephone_number": "773-371-2925",
            "fax_number": "773-371-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JIMMY",
        "credential": "LCSW, LPHA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-06",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149012281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Chan, PA-C
• Jaimie J Chan
• Jason Chan, PHARMD
• Jason H Chan, PHARMD
• Jessica H Chan, D.C.
• Jit Chan, DDS
• John Chan, RPH
• Juliana Chan, PHARM.D.
• Kimberly Karshue Chan, DDS
• Kristine N Chan, DPT

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.