Physician Compare National (NPI:1417026881)

HEALTHCARE PROVIDER: JACKIE CHAN DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1417026881
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749496362
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110106000316
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHAN
	Individual professional last name
Provider First Name	JACKIE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8337 TELEGRAPH RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 206
	Group Practice or individual's line 2 address
City	PICO RIVERA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	906604936
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5628061862
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y