Provider Demographics
NPI:1558496927
Name:MCCANN, JAN E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:E
Last Name:MCCANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:#143
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-768-9495
Mailing Address - Fax:949-768-8018
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:#143
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-768-9495
Practice Address - Fax:949-768-8018
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1844213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE000020Medicaid
CAT11073Medicare UPIN
CAWE7359Medicare ID - Type Unspecified