DR. CHARLES WILLIAM JACKSON (NPI# 1083662845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083662845 |
| Entity Type | Individual |
| Full Name | DR. CHARLES WILLIAM JACKSON |
| Credential | M.D. |
| Practice Address |
17122 Beach Blvd Suite 102 Huntington Beach CA 92647-5992 |
| Practice Telephone | 7148476545 |
| Practice Fax Number | 7148476547 |
| Mailing Telephone | 7148476545 |
| Mailing Fax Number | 7148476547 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2010-07-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | G35311 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G353110 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457896839 | Charles Jackson | Counselor | 2911 Penick St, Shreveport, LA 71109-4337 | 2016-12-21 |
| 1043655681 | Charles D Jackson | Driver | 4856 W.12th, Suite 1, Cleveland, OH 44109-3424 | 2013-05-09 |
| 1437594553 | Charles Jackson | Social Worker | 18712 Quarry St, Riverview, MI 48193-4527 | 2013-05-02 |
| 1508154105 | Charles Gilbert Jackson Jr. | Psychiatry & Neurology | 88 Crescent St, Northampton, MA 01060-2115 | 2011-07-16 |
| 1457669848 | Charles Edward Jackson Jr. | Psychologist | 1407 Healing Water Lane, N.las Vegas, NV 89031 | 2010-09-20 |
| 1588994081 | Charles Dustin Jackson | Counselor | 5004 Nw 26th St, Oklahoma City, OK 73127-1722 | 2010-01-05 |
| 1508985250 | Charles Arthur Jackson Jr. | Chiropractor | 2455 E Hill Rd, Grand Blanc, MI 48439 | 2007-03-27 |
| 1760535926 | Charles Jackson | Podiatrist | 820 N Dalmont St, Hobbs, NM 88240-5214 | 2007-01-19 |
| 1982769840 | Charles Jackson | Dentist | 3540 82nd St, Jackson Heights, NY 11372-5159 | 2006-12-22 |
| 1437224813 | Charles Wesley Jackson Jr. | Psychologist | 2980 Washington Blvd, Cleveland Heights, OH 44118-2450 | 2006-11-21 |
| Street Address |
17122 BEACH BLVD SUITE 102 |
| City | HUNTINGTON BEACH |
| State | CA |
| Zip Code | 92647-5992 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275598039 | New Life Healthcare, LLC | Clinic/Center | 17122 Beach Blvd, Suite 101, Huntington Beach, CA 92647-5992 | 2006-04-17 |
| 1437680527 | Kara Chelo | Physical Therapist | 17122 Beach Blvd, #101, Huntington Beach, CA 92647-5992 | 2017-03-21 |
| 1275994055 | Lisa Ha | Physical Therapist | 17122 Beach Blvd, Suite 101, Huntington Beach, CA 92647-5992 | 2016-03-08 |
| 1114359429 | Rubiceli Hernandez | Nurse Practitioner | 17122 Beach Blvd, Suite 102, Huntington Beach, CA 92647-5992 | 2013-08-09 |
| 1558527671 | Terry M. Imagawa, D.d.s., Inc. | Dentist | 17122 Beach Blvd, Suite 201, Huntington Beach, CA 92647-5992 | 2008-07-29 |
| 1851594006 | Charles W Jackson Md Inc | General Practice | 17122 Beach Blvd, Ste. 102, Huntington Beach, CA 92647-5992 | 2007-06-06 |
| 1902962087 | Andrea Louise You | Physical Therapist | 17122 Beach Blvd, Suite 101, Huntington Beach, CA 92647-5992 | 2006-12-31 |
| 1437237617 | New Life Rehabilitation, Inc. | Physical Therapist | 17122 Beach Blvd, Ste 101, Huntington Beach, CA 92647-5992 | 2006-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417464231 | Patricia Michelle Ramsey | Counselor | 16761 Viewpoint Lane, Apt 386, Huntington Beach, CA 92647 | 2018-01-02 |
| 1780103390 | Luz Flores | Health Educator | 8041 Newman Avenue, Hungtington Beach, CA 92647 | 2017-09-14 |
| 1134649106 | Louise Polzel | Social Worker | 17111 Beach Blvd St 205, Huntington Beach, CA 92647 | 2017-06-21 |
| 1205364015 | Chi Hong Nguyen | Family Medicine | 8201 Newman Ave 101, Huntington, CA 92647 | 2017-05-24 |
| 1396281770 | Sandra Vera | Specialist/Technologist | 7812 Edinger Ave. #400, Huntington Beach, CA 92647 | 2017-01-10 |
| 1245773050 | Sherika Benjamin | Technician, Pathology | 8211 San Angelo Drive Suit #f2, Huntington Beach, CA 92647 | 2016-11-28 |
| 1306389440 | Nhi Pham Nguyen | Behavioral Analyst | 17732 Beach Blvd., Suite G, Huntington Beach, CA 92647 | 2016-11-21 |
| 1710345095 | Pacific Beach Medical Group, Inc. | Internal Medicine | 16111 Beach Blvd., Huntington Beach, CA 92647 | 2016-02-02 |
| 1699148494 | Daniel Bui | Dentist | 16900-a Goldenwest St, Huntington Beach, CA 92647 | 2015-11-03 |
| 1598132359 | Hayley Patricia Buchanan | Specialist/Technologist | 23441 S. Pointe Drive, Suite 245, Laguna Hills, ORANGE COUNTY 92647 | 2015-08-27 |
| Find all providers in zip 92647 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578936423 | Abdel Ahmed | General Practice | 17093 Westport Dr, Huntington Beach, CA 92649-4246 | 2015-10-31 |
| 1386073849 | Tong Manh Tran | General Practice | 8311 Elmcrest Ln, Huntington Beach, CA 92646-3121 | 2013-11-05 |
| 1184986226 | David Stanley Poder | General Practice | 6289 Pacific Pointe Dr, Huntington Beach, CA 92648-7522 | 2012-06-14 |
| 1649530346 | William Taylor Hillyard | General Practice | 7915 Moonmist Cir, Huntington Beach, CA 92648-5442 | 2012-05-29 |
| 1407175243 | Scott Douglass Ewing | General Practice | 20001 Beach Blvd, Huntington Beach, CA 92648-3738 | 2010-05-18 |
| 1336373026 | Tad Fujioka | General Practice | 16842 Baruna Ln., Huntington Beach, CA 92649-3020 | 2009-05-08 |
| 1669525937 | Brian W. Capeloto | General Practice | 9042 Garfield Ave Ste 206, Huntington Beach, CA 92646-2340 | 2007-01-19 |
| 1376619890 | Richard B Levin | General Practice | 17832 Cardiff Cir, Huntington Beach, CA 92649-4807 | 2006-11-27 |
| 1326114828 | Richard B Levin Md Inc | General Practice | 17832 Cardiff Circle, Huntington Beach, CA 92649 | 2006-11-27 |
| 1063910172 | Landmark Connect of California PC | General Practice | 7755 Center Ave Ste 630, Huntington Beach, CA 92647-9152 | 2018-01-24 |
| Find all providers in HUNTINGTON BEACH | ||||
| City | HUNTINGTON BEACH |
| Zip Code | 92647 |
Please comment or provide details below to improve the information on DR. CHARLES WILLIAM JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.