Provider Demographics
NPI:1457818502
Name:CHIANG, JONATHAN YI-CHEN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:YI-CHEN
Last Name:CHIANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 OTIS DR
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5722
Mailing Address - Country:US
Mailing Address - Phone:510-523-7043
Mailing Address - Fax:
Practice Address - Street 1:2300 OTIS DR
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5722
Practice Address - Country:US
Practice Address - Phone:510-523-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist