Provider Demographics
NPI:1942338751
Name:CHAN, RODNEY JON (DPM)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:JON
Last Name:CHAN
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 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:STE 330
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1911
Mailing Address - Country:US
Mailing Address - Phone:415-731-6700
Mailing Address - Fax:415-759-8637
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:STE 330
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1911
Practice Address - Country:US
Practice Address - Phone:415-731-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2091213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6364019Medicaid
CA000E20910Medicare ID - Type Unspecified
CA6364019Medicaid