=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376997585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAKE CHUANG PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2016
-----------------------------------------------------
Last Update Date | 04/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3335 S FIGUEROA ST STE Q
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90007-3841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-742-6765
-----------------------------------------------------
Fax | 213-747-7392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 S GLADYS AVE UNIT A
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91776-2785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-525-3988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 71453
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------