Wayne Chan, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY27684 Issued in CA

Practice address

1205 Hearthstone LN
Santa Maria, CA 93454-4729

Phone

(510) 590-6865

NPI assigned

Mar 3, 2009

Last updated

Mar 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1669612727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 HEARTHSTONE LN",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544729",
            "telephone_number": "510-590-6865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 HEARTHSTONE LN",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544729",
            "telephone_number": "510-590-6865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 Ebenezer Church Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Sharpsburg",
            "state": "GA",
            "postal_code": "302772073",
            "country_code": "US",
            "telephone_number": "404-960-1282",
            "fax_number": "855-817-2428",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "420 Thomaston St",
            "address_purpose": "LOCATION",
            "city": "Zebulon",
            "state": "GA",
            "postal_code": "302953387",
            "country_code": "US",
            "telephone_number": "404-960-1282",
            "fax_number": "855-817-2428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "WAYNE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-03",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY004177",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY27684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Ida Chacon, AMFT
• Loretta M Chacon, RMA/AOD/CERT
• Stephany Chacon
• Brent Cham, MD
• Ana P. Champagne, LMFT
• Ian Chang, D.D.S.
• Jason Chang, O.D.
• Andrew Changala
• Changing Faces Inc
• Ashley Alexandra Kitto Channer, DDS

• Clinical Psychologist in Santa Maria, CA
• Providers in Santa Maria, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; 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.