Provider Demographics
NPI:1225561095
Name:DUNHAM, JONATHAN R (PA-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9291
Mailing Address - Country:US
Mailing Address - Phone:925-285-2098
Mailing Address - Fax:
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 530
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-422-5150
Practice Address - Fax:510-422-5149
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant