JACKIE T. CHAN, M.D., INC. – NPI #1396954921
Clinic/Center

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

Health Care Provider Taxonomy Code for Clinic/Center

JACKIE T. CHAN, M.D., INC. is an AHC clinic located in MODESTO, CA. NPPES has assigned the NPI number 1396954921 to JACKIE T. CHAN, M.D., INC. on May 21, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QM2500X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Medical Specialty

The NPI profile was previously updated about 3 years ago on Aug 24, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for JACKIE T. CHAN, M.D., INC. below.

NPI Profile for
JACKIE T. CHAN, M.D., INC.

NPI Number
1396954921
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
JACKIE T. CHAN, M.D., INC.
Primary location
413 E ORANGEBURG AVE STE A
MODESTO, CA 95350-5369
Phone: (209) 543-8880 Fax: (209) 529-1711
Mailing address
4120 DALE RD
STE J8 #232
MODESTO, CA 95356-9239
Phone: (209) 529-4422 Fax: (209) 529-1711
Organization Subpart
No
Authorized Official
JACKIE CHAN
PRESIDENT
Phone: (209) 529-4422
Updated
Certification Date
Aug 24, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QM2500X
- Clinic/Center / Medical Specialty (Primary)		 CA G077865
261QP3300X
- Clinic/Center / Pain		 CA G077865

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.