Von Chan, D.D.S., INC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

46650 Issued in CA

Practice address

1416 Professional Dr
Ste. #201
Petaluma, CA 94954-5108

Phone

(707) 763-2682

Fax

(707) 763-4998

NPI assigned

Jul 18, 2006

Last updated

Oct 9, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223510400000",
    "number": "1922027440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1416 PROFESSIONAL DR",
            "address_2": "STE. #201",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949545108",
            "telephone_number": "707-763-2682",
            "fax_number": "707-763-4998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1416 PROFESSIONAL DR",
            "address_2": "STE. #201",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949545108",
            "telephone_number": "707-763-2682",
            "fax_number": "707-763-4998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "VON",
        "name_prefix": "Dr.",
        "credential": "D.D.S., INC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "46650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriana Chacon-Kreysa
• Aimee C Chagnon, MD
• Shannon Dawn Chain, MD
• Sherin Ann Chakkalakel, DNP, FNP-C
• Adrian Zhiwen Chan
• Kevin Chang, PHARMD
• Channel Medical Group of California, P.C.
• Frank Chao, O.D.
• David Allen Chappell, M.D.
• Ashley Chavez

• General Practice Dentistry in Petaluma, CA
• Providers in Petaluma, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.