Fairway Children's Medical Group

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

FAIRWAY CHILDREN'S MEDICAL GROUP

Practice address

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

Phone

(909) 594-3382

Fax

(626) 667-7633

NPI assigned

Jul 13, 2022

Last updated

Apr 23, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jackyln Chan, MDNPI 1447544333

Title

Owner

Phone

(909) 630-8762

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jackyln Wai-Shan Chan, M.D.

  • Pediatrics Physician
  • West Covina, CA
  • NPI 1447544333

  Single Specialty

  NPD Authorized official
• Tiffany Thanh Nguyen, MD, MS

  • Pediatrics Physician
  • Diamond Bar, CA
  • NPI 1356083927
  NPD
• Michelle Perea Saupan, NP

  • Family Nurse Practitioner
  • Diamond Bar, CA
  • NPI 1336038892
  NPD
• Jessica Wang, FNP-C

  • Family Nurse Practitioner
  • Brea, CA
  • NPI 1487485470
  NPD
• Monica Avila, NP

  • Pediatric Nurse Practitioner
  • South Gate, CA
  • NPI 1447069943
  NPD (past)
• Sarah Chu

  • Physician Assistant
  • Diamond Bar, CA
  • NPI 1366197998

  Single Specialty

  NPD (past)
• Crystal Hui

  • Physician Assistant
  • Laguna Hills, CA
  • NPI 1427838234
  NPD (past)
• Elsa Ann Castanon Quintana, FNP-C

  • Family Nurse Practitioner
  • Diamond Bar, CA
  • NPI 1588365076
  NPD (past)

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1700510898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 BREA CANYON RD STE 330",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917893095",
            "telephone_number": "909-594-3382",
            "fax_number": "626-667-7633"
        },
        {
            "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",
            "fax_number": "626-667-7633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "888 Brea Canyon Rd Ste 330",
            "address_purpose": "LOCATION",
            "city": "Diamond Bar",
            "state": "CA",
            "postal_code": "917893095",
            "country_code": "US",
            "telephone_number": "909-594-3382",
            "fax_number": "626-667-7633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAIRWAY CHILDREN'S MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "JACKYLN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-630-8762",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MD STATE LICENSE #",
            "identifier": "A130711",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL TYPE 1 NPI",
            "identifier": "1447544333",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moses Ewo
• Excel Imaging Center West Covina Inc.
• Eyehome Network of California, an Optometric Corporation
• Eyexam of California
• Anthony Curtis Ezedi
• Natalia Isabel Fajardo
• David Falcon-Valentin
• Raymon Joe Falcon
• Family Associated Medical Group Inc.
• Family Care Transportation,Inc.

• 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 Apr 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.