Basic Information
| Provider Information | |||||||||
| NPI: | 1225561095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNHAM | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 LAKE VIEW DR | ||||||||
| Address2: | |||||||||
| City: | COLFAX | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957139291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252852098 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | SUITE 530 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104225150 | ||||||||
| FaxNumber: | 5104225149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 04/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 54343 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.