Active NPI
Wilson Chan, DMD
- General Practice Dentistry
- Philadelphia, PA
National Provider Identifier
1952830002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS041841
- Practice address
- 1207 Chestnut St 4TH Floor
Philadelphia, PA 19107-4131 - Phone
- (215) 525-3046
- Fax
- (215) 567-1617
- NPI assigned
- Jun 11, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS041841 | PA | |
| General Practice Dentistry | 1223G0001X | DS041841 | PA | Primary |
Addresses
Primary practice location
1207 Chestnut St 4TH Floor
Philadelphia, PA 19107-4131
Mailing address
1233 Locust St FL 3
Philadelphia, PA 19107-5400
Phone (215) 985-4448
Other practice location 1
5501 Old York Rd
Philadelphia, PA 19141-3018
Phone (215) 456-7130
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1036229380001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Philadelphia, PA
- NPI 1760507859
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578268800000",
"number": "1952830002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1233 LOCUST ST FL 3",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191075400",
"telephone_number": "215-985-4448",
"fax_number": "215-732-1478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1207 CHESTNUT ST 4TH FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191074131",
"telephone_number": "215-525-3046",
"fax_number": "215-567-1617"
}
],
"practiceLocations": [
{
"address_1": "5501 Old York Rd",
"address_purpose": "LOCATION",
"city": "Philadelphia",
"state": "PA",
"postal_code": "191413018",
"country_code": "US",
"telephone_number": "215-456-7130",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHAN",
"first_name": "WILSON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-11",
"last_updated": "2020-01-06",
"certification_date": "2020-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS041841",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PA",
"license": "DS041841",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1036229380001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; 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.