Healthcare Provider Details

I. General information

NPI: 1659227247
Provider Name (Legal Business Name): JENNIFER CHAN PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 N MUSCATEL AVE
SAN GABRIEL CA
91775-1845
US

IV. Provider business mailing address

6415 N MUSCATEL AVE
SAN GABRIEL CA
91775-1845
US

V. Phone/Fax

Practice location:
  • Phone: 626-548-5084
  • Fax:
Mailing address:
  • Phone: 626-548-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230115208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: