Healthcare Provider Details

I. General information

NPI: 1164381679
Provider Name (Legal Business Name): MR. KIAN JOSHUA CHANOWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINDEN ST
OAKLAND CA
94607-2538
US

IV. Provider business mailing address

647 PARK HILL RD
DANVILLE CA
94526-3615
US

V. Phone/Fax

Practice location:
  • Phone: 925-338-0338
  • Fax:
Mailing address:
  • Phone: 925-336-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: