MEDICARE: JENNIFER CHAN PPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	230115208	CA

General Provider Information

NPI Number	:	1659227247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHAN PPS

Provider Business Mailing Address
First Line	:	6415 N MUSCATEL AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1845
Country	:	US
Telephone Number	:	626-548-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	6415 N MUSCATEL AVE
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1845
Country	:	US
Telephone Number	:	626-548-5084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ JENNIFER CHAN PPS” Practice Location

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