Provider Demographics
NPI:1982373015
Name:CHE, JOHNATHAN
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:CHE
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 1:2319 E WASHINGTON BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-1945
Mailing Address - Country:US
Mailing Address - Phone:626-797-8800
Mailing Address - Fax:
Practice Address - Street 1:2319 E WASHINGTON BLVD # 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1945
Practice Address - Country:US
Practice Address - Phone:626-797-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-12-01
Deactivation Date:2021-10-25
Deactivation Code:
Reactivation Date:2021-11-11
Provider Licenses
StateLicense IDTaxonomies
CA95018375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty