Individual provider Active NPI

Wen-Chun Jimmy Lan, MD, MS

  • Neonatal-Perinatal Medicine Physician
  • Santa Maria, CA
National Provider Identifier
1750452447
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
A92292 Issued in CA
Practice address
235 S Palisade Dr
Santa Maria, CA 93454
Phone
(805) 739-3961
NPI assigned
Nov 13, 2006
Last updated
Nov 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X A92292 CA Primary
Pediatrics Physician 208000000X A92292 CA

Addresses

Primary practice location

235 S Palisade Dr
Santa Maria, CA 93454

Mailing address

235 S Palisade Dr
Santa Maria, CA 93454-5948
Phone (805) 739-3561

Other practice location 1

9300 Valley Childrens Pl # Sc05
Madera, CA 93636-8761
Phone (559) 353-8769

Other identifiers 1

IdentifierTypeStateIssuer
00A922920MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070703000668 CA Practitioner - Other (Physician)Practitioner - Pediatric Medicine 8820198807 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Master of Science

State licenses

LicenseStateTypeSpecialty
A92292CAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Children's Medical Group Pediatrics CurrentSince May 15, 2015 Accepting new patients
Valley Children's Specialty Medical Group, Inc. Pediatrics Past Accepting new patients
LPCH Medical Group Div of Lucile Pediatrics Past Accepting new patients
County of Santa Clara Pediatrics Past Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

9300 Valley Childrens Pl
Madera, CA 93636
Phone (559) 353-5700

9300 Valley Childrens Pl
#5
Madera, CA 93636
Phone (559) 353-5700

1524 McHenry Ave
Ste 550570
Modesto, CA 95350
Phone (209) 572-3880

1400 E Church St
Bldg 8
Santa Maria, CA 93454
Phone (800) 739-3561

1400 E Church St
Ofc
Santa Maria, CA 93454
Phone (805) 739-3112

Interoperability endpoints

  • Direct secure messaging: jlan15820@valleychildrens-prd.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1750452447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 S PALISADE DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934545948",
            "telephone_number": "805-739-3561",
            "fax_number": "805-739-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S PALISADE DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "93454",
            "telephone_number": "805-739-3961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9300 Valley Childrens Pl # Sc05",
            "address_purpose": "LOCATION",
            "city": "Madera",
            "state": "CA",
            "postal_code": "936368761",
            "country_code": "US",
            "telephone_number": "559-353-8769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAN",
        "first_name": "WEN-CHUN",
        "middle_name": "JIMMY",
        "credential": "MD, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "A92292",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A92292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A922920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.