Individual
JACKIE CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
8337 TELEGRAPH RD, SUITE 206, PICO RIVERA, CA 90660-4909
(562) 806-1862
(562) 928-6542
Mailing address
8337 TELEGRAPH RD, SUITE 206, PICO RIVERA, CA 90660-4909
(562) 806-1862
(562) 928-6542
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E2120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00021200
—
CA
01
—
E2120
CA MEDICAL LICENSE
CA
Enumeration date
11/07/2006
Last updated
09/14/2012
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