Healthcare Provider Details

I. General information

NPI: 1801604079
Provider Name (Legal Business Name): JERRETT CHOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N TRACY BLVD
TRACY CA
95376-3451
US

IV. Provider business mailing address

3045 HERMOSA AVE
LA CRESCENTA CA
91214-3710
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-1500
  • Fax:
Mailing address:
  • Phone: 818-334-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberNP95031332
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: