Provider Demographics
NPI:1841283892
Name:CHURNIN, JON W (INCORPORATED)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:W
Last Name:CHURNIN
Suffix:
Gender:M
Credentials:INCORPORATED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 ELM ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2640
Mailing Address - Country:US
Mailing Address - Phone:650-343-9746
Mailing Address - Fax:650-343-9746
Practice Address - Street 1:901 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-991-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2022-08-30
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAG34291207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine