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General NPI Number Information
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NPI Number | 1194352930
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Entity Type | Organization
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Legal Business Name | JACQUELINE S CHAN DO A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 1118 IRWIN ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3322
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Country | US
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Telephone | 415-785-8652
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 IRWIN ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DO / OWNER
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Name | JACQUELINE CHAN
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Credential | DO
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Telephone | 415-785-8652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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