Provider Demographics
NPI:1881761203
Name:CHAFFEE, JON (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:CHAFFEE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 E 2ND ST # 546
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5324
Mailing Address - Country:US
Mailing Address - Phone:951-244-4147
Mailing Address - Fax:951-244-0747
Practice Address - Street 1:5318 E 2ND ST # 546
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5324
Practice Address - Country:US
Practice Address - Phone:562-433-3220
Practice Address - Fax:562-439-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG693732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G693732Medicaid
CA00G693732Medicaid
CAG69373AMedicare ID - Type Unspecified