Healthcare Provider Details

I. General information

NPI: 1134895287
Provider Name (Legal Business Name): JIWAN S CHHINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8632 SPRING VISTA WAY
SPRING VALLEY CA
91977-4021
US

IV. Provider business mailing address

8632 SPRING VISTA WAY
SPRING VALLEY CA
91977-4021
US

V. Phone/Fax

Practice location:
  • Phone: 619-337-5201
  • Fax:
Mailing address:
  • Phone: 161-933-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number204842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: