Provider Demographics
NPI:1275237422
Name:CHAE, JAY (NP)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:CHAE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15237 ELEVENTH ST STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3736
Mailing Address - Country:US
Mailing Address - Phone:760-493-9300
Mailing Address - Fax:760-493-9400
Practice Address - Street 1:15237 ELEVENTH ST STE C
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3736
Practice Address - Country:US
Practice Address - Phone:760-493-9300
Practice Address - Fax:760-493-9400
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95024404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily