Healthcare Provider Details

I. General information

NPI: 1225711781
Provider Name (Legal Business Name): JONATHAN YOUNGFAN CHAO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 9TH ST STE B
CHINO CA
91710-3528
US

IV. Provider business mailing address

1156 S MUIRFIELD RD
LOS ANGELES CA
90019-1826
US

V. Phone/Fax

Practice location:
  • Phone: 909-902-0009
  • Fax:
Mailing address:
  • Phone: 323-381-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: