Active NPI
John Chan, PA
- Pediatric Adolescent Medicine Physician
- Perris, CA
National Provider Identifier
1447306980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- PA11478
- Practice address
- 215 W 4TH St
Perris, CA 92570-2010 - Phone
- (951) 486-5700
- Fax
- (951) 486-5705
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | PA11478 | CA | Primary |
Addresses
Primary practice location
215 W 4TH St
Perris, CA 92570-2010
Mailing address
PO Box 7270
Moreno Valley, CA 92552-7270
Phone (951) 486-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA11478 | CA | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447306980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7270",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925527270",
"telephone_number": "951-486-5700",
"fax_number": "951-486-5705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 W 4TH ST",
"city": "PERRIS",
"state": "CA",
"postal_code": "925702010",
"telephone_number": "951-486-5700",
"fax_number": "951-486-5705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "JOHN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "CA",
"license": "PA11478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perris, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.