Healthcare Provider Details

I. General information

NPI: 1134009699
Provider Name (Legal Business Name): JORGE CHANON EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 GRANT CT UNIT 102
WAHIAWA HI
96786-6331
US

IV. Provider business mailing address

194 GRANT CT UNIT 102
WAHIAWA HI
96786-6331
US

V. Phone/Fax

Practice location:
  • Phone: 559-283-4845
  • Fax:
Mailing address:
  • Phone: 559-283-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3250855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: