Provider Demographics
NPI:1376997585
Name:CHUANG, JAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:
Last Name:CHUANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S GLADYS AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2785
Mailing Address - Country:US
Mailing Address - Phone:909-525-3988
Mailing Address - Fax:
Practice Address - Street 1:3335 S FIGUEROA ST STE Q
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3841
Practice Address - Country:US
Practice Address - Phone:213-742-6765
Practice Address - Fax:213-747-7392
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist