Basic Information
| Provider Information | |||||||||
| NPI: | 1497117071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIANG | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2660 W COVELL BLVD | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956165645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307473000 | ||||||||
| FaxNumber: | 5307473093 | ||||||||
| Practice Location | |||||||||
| Address1: | 2660 W COVELL BLVD | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956165645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307473000 | ||||||||
| FaxNumber: | 5307473093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2016 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A17021 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.