Jackyln Wai-Shan Chan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A130711 Issued in CA

Practice address

2707 E Valley Blvd Ste 215
West Covina, CA 91792-3197

Phone

(909) 594-3382

NPI assigned

Jun 8, 2011

Last updated

Jul 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Fairway Children's Medical Group

  • Pediatrics Physician
  • West Covina, CA
  • NPI 1700510898

  Single Specialty

  NPD Authorized official
• Emanate Health Medical Center

  dba Citrus Valley Medical Center Queen Of the Valley Campus

  • General Acute Care Hospital
  • West Covina, CA
  • NPI 1063441293

  Single Specialty

  NPD (past)
• Pomona Valley Hospital Medical Center

  • General Acute Care Hospital
  • Pomona, CA
  • NPI 1518067586
  NPD (past)
• Texas Children's Hospital

  • Children's Hospital
  • Houston, TX
  • NPI 1477643690
  NPD (past)

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

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1447544333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD STE 215",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923197",
            "telephone_number": "909-594-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 E VALLEY BLVD STE 215",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917923197",
            "telephone_number": "909-594-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JACKYLN",
        "middle_name": "WAI-SHAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-08",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A130711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Champion Care Hospice, Inc.
• Carrie Pui-See Chan, PHARMD
• Cheuk Man Chan
• Collin Chan
• Eva Y Chan, M.D.
• PO Kin Chan
• Priscilla Chan, PT, DPT
• Wayman M. Chan, D.D.S.
• Christine M. Chang, O.D.
• Chuhui Faith Chang

• Pediatrics Physician in West Covina, CA
• Providers in West Covina, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; 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.