Stephanie Chan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

108886 Issued in CA

Practice address

16387 First Street
Guerneville, CA 95446

Phone

(707) 869-2849

NPI assigned

May 24, 2023

Last updated

Jul 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1684886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1700578002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "878 LOS ROBLES AVE",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943063124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16387 FIRST STREET",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "95446",
            "telephone_number": "707-869-2849"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "878 Los Robles Ave",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "943063124",
            "country_code": "US",
            "telephone_number": "650-833-9758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAN",
        "first_name": "STEPHANIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-07-05",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "108886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Blancke
• Teresa Bowden
• Steven Bromer, MD
• Sarah Marie Caldwell, SUDRC II
• California Human Development Corporation
• County of Sonoma
• Jessica A Cowsert
• Cynthia Berman, PH.D (cynthia berman)
• Jaime Dahl
• Christy Davila, MS, LMFT

• Dentist in Guerneville, CA
• Providers in Guerneville, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.