MEDICARE: DR. JACOB ANDREW CHACKO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A131541	CA

General Provider Information

NPI Number	:	1245563949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB ANDREW CHACKO M.D.

Provider Business Mailing Address
First Line	:	2345 CALIFORNIA ST STE 5
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2722
Country	:	US
Telephone Number	:	415-857-3624
Fax Number	:	650-285-1793

Provider Business Practice Location Address
First Line	:	2345 CALIFORNIA ST STE 5
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2722
Country	:	US
Telephone Number	:	415-857-3624
Fax Number	:	650-285-1793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2009
Last Update Date	:	03/30/2026

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