Provider Demographics
NPI:1134211964
Name:CHAN, JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 2598
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-2598
Mailing Address - Country:US
Mailing Address - Phone:562-804-1381
Mailing Address - Fax:562-925-8898
Practice Address - Street 1:5220 CLARK AVE STE 125
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2623
Practice Address - Country:US
Practice Address - Phone:562-804-1381
Practice Address - Fax:562-925-8898
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3254213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3254OtherLICENSE
CAWE3254AMedicare PIN