Organization
JACKIE T. CHAN, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKIE CHAN M.D. (PRESIDENT)
(209) 529-4422
Entity
Organization
Contact information
Practice address
413 E ORANGEBURG AVE STE A, MODESTO, CA 95350-5369
(209) 543-8880
(209) 529-1711
Mailing address
4120 DALE RD, STE J8 #232, MODESTO, CA 95356-9239
(209) 529-4422
(209) 529-1711
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G077865
CA
261QP3300X
Pain Clinic/Center
G077865
CA
Other
Enumeration date
05/21/2007
Last updated
08/24/2023
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