Provider Demographics
NPI:1134895287
Name:CHHINA, JIWAN S
Entity type:Individual
Prefix:
First Name:JIWAN
Middle Name:S
Last Name:CHHINA
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 1:8632 SPRING VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-4021
Mailing Address - Country:US
Mailing Address - Phone:161-933-7520
Mailing Address - Fax:
Practice Address - Street 1:8632 SPRING VISTA WAY
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4021
Practice Address - Country:US
Practice Address - Phone:619-337-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204842164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse