Hiedi M Chan, MA
Individual provider Active NPI Marriage & Family Therapist · Lakeside, CA
NPI 1497942320 · NPPES record last updated Feb 26, 2016
Key facts
- NPI
- 1497942320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 50813 (CA)
- Practice address
- 13037 Yerba Valley Way
Lakeside, CA 92040-1567 - Phone
- (858) 945-4241
- NPI assigned
- Sep 25, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50813 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hiedi Chan Marriage and Family Therapy Incorporated | Marriage & Family Therapist | Current |
Accepting new patients |
Locations
3160 Camino del Rio S
Ste 116
San Diego, CA 92108
Phone (619) 352-0486
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 50813 | CA | Yes |
Addresses
Primary practice location
13037 Yerba Valley Way
Lakeside, CA 92040-1567
Mailing address
2423 Camino del Rio S Ste 101
San Diego, CA 92108-3734
Phone (858) 945-4241
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All providers in Lakeside, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.