Active NPI
Wiley Vernon Chan, MD
- Internal Medicine Physician
- Portland, OR
National Provider Identifier
1669588828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- OR MD13983
- Practice address
- 500 NE Multnomah St
Suite 100, KPB-2
Portland, OR 97232-2023 - Phone
- (503) 813-3860
- NPI assigned
- Aug 21, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OR MD13983 | OR | Primary |
| Internal Medicine Physician | 207R00000X | WA MD00034553 | WA |
Addresses
Primary practice location
500 NE Multnomah St
Suite 100, KPB-2
Portland, OR 97232-2023
Mailing address
500 NE Multnomah St
Suite 100, KPB-2
Portland, OR 97232-2023
Phone (503) 813-3860
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OR MD13983 | OR | MD | Internal Medicine Physician |
| WA MD00034553 | WA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438992000000",
"number": "1669588828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 NE MULTNOMAH ST",
"address_2": "SUITE 100, KPB-2",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322023",
"telephone_number": "503-813-3860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 NE MULTNOMAH ST",
"address_2": "SUITE 100, KPB-2",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322023",
"telephone_number": "503-813-3860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "WILEY",
"middle_name": "VERNON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2015-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OR",
"license": "OR MD13983",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "WA MD00034553",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.