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General NPI Number Information
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NPI Number | 1245563949
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Entity Type | Individual
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Provider Name | JACOB ANDREW CHACKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2009
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 815 HYDE ST STE 317C
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-5996
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Country | US
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Telephone | 415-857-3624
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Fax | 650-285-1793
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Provider Business Mailing Address
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Address Line | 1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
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City | TRIPLER ARMY MEDICAL CENTER
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State | HI
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Zip | 96859-5001
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A131541
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License Number State | CA
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