Provider Demographics
NPI:1295843076
Name:CHANN, JAGMEET K (MD)
Entity Type:Individual
Prefix:
First Name:JAGMEET
Middle Name:K
Last Name:CHANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6089 N FIRST ST
Mailing Address - Street 2:#101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5444
Mailing Address - Country:US
Mailing Address - Phone:559-449-8060
Mailing Address - Fax:559-449-9440
Practice Address - Street 1:6089 N FIRST ST
Practice Address - Street 2:#101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5444
Practice Address - Country:US
Practice Address - Phone:559-449-8060
Practice Address - Fax:559-449-9440
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA378642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A88432Medicare UPIN
CA00A378640Medicare ID - Type Unspecified