Provider Demographics
NPI:1487789798
Name:JAN E MC CANN DPM INC
Entity type:Organization
Organization Name:JAN E MC CANN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-364-5180
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:#322
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:949-364-5180
Mailing Address - Fax:949-768-8018
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:#322
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-364-5180
Practice Address - Fax:949-768-8018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1844213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14314Medicare ID - Type Unspecified
CAT11073Medicare UPIN
CAWE1844BMedicare ID - Type Unspecified