Healthcare Provider Details

I. General information

NPI: 1356271738
Provider Name (Legal Business Name): JAM CHOOKAEW PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST
SAN DIEGO CA
92103-2231
US

IV. Provider business mailing address

3621 PARK BLVD APT E
SAN DIEGO CA
92103-4543
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-3300
  • Fax:
Mailing address:
  • Phone: 703-509-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number306352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: