MEDICARE: JODY 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1770212060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY CHAN

Provider Business Mailing Address
First Line	:	2101 N GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2828
Country	:	US
Telephone Number	:	818-848-8825
Fax Number	:	818-848-8886

Provider Business Practice Location Address
First Line	:	10834 WHITTIER BLVD STE 101
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-1402
Country	:	US
Telephone Number	:	562-846-4445
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	01/13/2026

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Directions to “ JODY CHAN ” Practice Location

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