Jackie TSZ-Kit Chan, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

G077865 Issued in CA

Practice address

413 E Orangeburg Ave Ste a
Modesto, CA 95350-5369

Phone

(209) 529-4422

Fax

(209) 529-1711

NPI assigned

Apr 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Jackie T. Chan, M.D., Inc.

  • Medical Specialty Clinic/Center
  • Modesto, CA
  • NPI 1396954921
  Authorized official Same address or phone
• Doctors Medical Center of Modesto, Inc.

  dba Doctors Medical Center of Modesto

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1184654923

  Interventional Pain Medicine

  NPD (past)
• Sutter Valley Hospitals

  dba Memorial Medical Center

  • General Acute Care Hospital
  • Modesto, CA
  • NPI 1699129601

  Interventional Pain Medicine

  NPD (past)

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1801850953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 DALE RD",
            "address_2": "STE J-8 #232",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569239",
            "telephone_number": "209-529-4422",
            "fax_number": "209-529-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 E ORANGEBURG AVE STE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953505369",
            "telephone_number": "209-529-4422",
            "fax_number": "209-529-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JACKIE",
        "middle_name": "TSZ-KIT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "CA",
            "license": "G077865",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CA",
            "license": "G077865",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "G077865",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "G077865",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "G077865",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sadie-Marie Chambers
• Ronald Lynn Champion, D.D.S.
• Addison Chan
• Christina Chan, M.D.
• Christine Yaju Chan, M.D.
• Jessica Chan, PA-C
• John C Chan, M.D.
• Kaity M. Chan, PHARM.D.
• Phillip Michael Chan, M.D.
• Somayah Chan

• Physical Medicine & Rehabilitation Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.