Provider Demographics
NPI:1134009699
Name:CHANON, JORGE (EMT-B)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:
Last Name:CHANON
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 GRANT CT UNIT 102
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-6331
Mailing Address - Country:US
Mailing Address - Phone:559-283-4845
Mailing Address - Fax:
Practice Address - Street 1:194 GRANT CT UNIT 102
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-6331
Practice Address - Country:US
Practice Address - Phone:559-283-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3250855146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic