Healthcare Provider Details

I. General information

NPI: 1861802613
Provider Name (Legal Business Name): JESSICA CHIEH-TING CHUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 10/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE BUILDING 1, 1ST FLOOR, DEPARTMENT #107
RICHMOND CA
94801
US

IV. Provider business mailing address

120 WARD ST # 1044
LARKSPUR CA
94939-1325
US

V. Phone/Fax

Practice location:
  • Phone: 415-504-2342
  • Fax:
Mailing address:
  • Phone: 415-504-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number60733222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: