Healthcare Provider Details

I. General information

NPI: 1427968817
Provider Name (Legal Business Name): JADE CHELAI PATSCHULL RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 CORONA AVE
LONG BEACH CA
90803-1810
US

IV. Provider business mailing address

360 W 14TH ST
SAN PEDRO CA
90731-4214
US

V. Phone/Fax

Practice location:
  • Phone: 310-938-8836
  • Fax:
Mailing address:
  • Phone: 310-938-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP1269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: