Provider Demographics
NPI:1225711781
Name:CHAO, JONATHAN YOUNGFAN (PA-S)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:YOUNGFAN
Last Name:CHAO
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 S MUIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1826
Mailing Address - Country:US
Mailing Address - Phone:323-381-8141
Mailing Address - Fax:
Practice Address - Street 1:1156 S MUIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1826
Practice Address - Country:US
Practice Address - Phone:323-381-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program