Healthcare Provider Details

I. General information

NPI: 1548779168
Provider Name (Legal Business Name): JACOB CHAI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY STE 351
MISSION VIEJO CA
92691-6374
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY SUITE 351
MISSION VIEJO CA
92691
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1007
  • Fax:
Mailing address:
  • Phone: 949-364-1007
  • Fax: 949-364-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95007242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: