Active NPI
Richard Wilkin Chan, DDS MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bothell, WA
National Provider Identifier
1457519308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DE00011234
- Practice address
- 19020 Bothell Way NE
Suite a
Bothell, WA 98011-2996 - Phone
- (425) 485-9332
- Fax
- (425) 486-0935
- NPI assigned
- May 28, 2008
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DE00011234 | WA | Primary |
Addresses
Primary practice location
19020 Bothell Way NE
Suite a
Bothell, WA 98011-2996
Mailing address
19020 Bothell Way NE
Suite a
Bothell, WA 98011-2996
Phone (425) 485-9332
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00011234 | WA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chan Braces | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Bothell, WA
- NPI 1780518837
Orthodontics and Dentofacial Orthopedics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450310400000",
"number": "1457519308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19020 BOTHELL WAY NE",
"address_2": "SUITE A",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980112996",
"telephone_number": "425-485-9332",
"fax_number": "425-486-0935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19020 BOTHELL WAY NE",
"address_2": "SUITE A",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980112996",
"telephone_number": "425-485-9332",
"fax_number": "425-486-0935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "RICHARD",
"middle_name": "WILKIN",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-28",
"last_updated": "2015-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WA",
"license": "DE00011234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bothell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.