Provider Demographics
NPI:1245563949
Name:CHACKO, JACOB ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ANDREW
Last Name:CHACKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 HYDE ST STE 317C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5996
Practice Address - Country:US
Practice Address - Phone:415-857-3624
Practice Address - Fax:650-285-1793
Is Sole Proprietor?:No
Enumeration Date:2009-09-12
Last Update Date:2020-01-23
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Provider Licenses
StateLicense IDTaxonomies
CAA1315412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN