Provider Demographics
NPI:1962993238
Name:CHEN, JUSTIN JIE
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JIE
Last Name:CHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 N CALIFORNIA AVE STE F602
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-8564
Mailing Address - Country:US
Mailing Address - Phone:773-878-3627
Mailing Address - Fax:773-878-0985
Practice Address - Street 1:5215 N CALIFORNIA AVE STE F602
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-8564
Practice Address - Country:US
Practice Address - Phone:773-878-3627
Practice Address - Fax:773-878-0985
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine