MEDICARE: JENNIFER CHAN MD

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	208200000X	Plastic Surgery Physician	MD2007-0451	NM
2	208600000X	Surgery Physician	MD2007-0451	NM

General Provider Information

NPI Number	:	1184763195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHAN MD

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	SANDIA PLASTIC SURGERY
Second Line	:	1020 TIJERAS AVE. NE
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4749
Country	:	US
Telephone Number	:	505-842-6868
Fax Number	:	505-842-9325

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/16/2026

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Directions to “ JENNIFER CHAN MD” Practice Location

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