Provider Demographics
NPI:1629104005
Name:JAN E MC CANN DPM
Entity Type:Organization
Organization Name:JAN E MC CANN DPM
Other - Org Name:SADDLEBACK VALLEY PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-768-9495
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1844213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ87084ZOtherBLUE SHIELD
CAT11073Medicare UPIN
CAGRE000020Medicare ID - Type Unspecified
CAWE7359Medicare ID - Type Unspecified