MEDICARE: JACQUELINE BAYADING CHAN

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	363LF0000X	Family Nurse Practitioner	95017629	CA

General Provider Information

NPI Number	:	1770240434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BAYADING CHAN

Provider Business Mailing Address
First Line	:	20639 LEMMER ST
Second Line	:
City	:	CHATSWORTH
State	:	CA
Zip	:	91311-4502
Country	:	US
Telephone Number	:	818-519-6072
Fax Number	:	818-782-7320

Provider Business Practice Location Address
First Line	:	4312 WOODMAN AVE STE 300
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-5514
Country	:	US
Telephone Number	:	818-922-2129
Fax Number	:	818-922-2025

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	10/27/2025

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