Healthcare Provider Details

I. General information

NPI: 1497117071
Provider Name (Legal Business Name): JONATHAN PAUL CHIANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W COVELL BLVD
DAVIS CA
95616-5645
US

IV. Provider business mailing address

2660 W COVELL BLVD
DAVIS CA
95616-5645
US

V. Phone/Fax

Practice location:
  • Phone: 530-747-3000
  • Fax: 530-747-3093
Mailing address:
  • Phone: 530-747-3000
  • Fax: 530-747-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: