Provider Demographics
NPI:1972543239
Name:CHEN, JASON TSAI (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TSAI
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VILLAGE CENTER DR UNIT 204
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-4540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:773-768-6141
Practice Address - Street 1:8012 S CRANDON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1124
Practice Address - Country:US
Practice Address - Phone:773-356-5415
Practice Address - Fax:773-768-6141
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76587207R00000X
IL036126956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036.126956OtherILLINOIS MEDICAL LICENSE NUMBER
CAA76587OtherLICENSE NUMBER
I18420Medicare UPIN