# JACKIE T. CHAN, M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396954921
- **Authorized official:** DR. JACKIE CHAN M.D. (PRESIDENT)
- **Authorized official phone:** (209) 529-4422

## Contact information

- **Practice address:** 413 E ORANGEBURG AVE STE A, MODESTO, CA 95350-5369
- **Practice address phone:** (209) 543-8880
- **Practice address fax:** (209) 529-1711
- **Mailing address:** 4120 DALE RD, STE J8 \#232, MODESTO, CA 95356-9239
- **Mailing address phone:** (209) 529-4422
- **Mailing address fax:** (209) 529-1711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G077865 | CA | Yes |
| 261QP3300X | Pain Clinic/Center | G077865 | CA | — |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 08/24/2023