Basic Information
| Provider Information | |||||||||
| NPI: | 1063495869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | JAY | ||||||||
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| Credential: | DPT ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 SOBRANTE WAY | ||||||||
| Address2: | |||||||||
| City: | SUNNYVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940864807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087333670 | ||||||||
| FaxNumber: | 4082457968 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 W EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN VIEW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940402610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6509617370 | ||||||||
| FaxNumber: | 6509612360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT27391 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.