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NPI Code Detail

MEDICARE: JASMINE PERNG

MEDICARE:   JASMINE  PERNG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1609699933
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE PERNG
Provider Business Mailing Address
First Line : 5136 N KIMBALL AVE APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60625-4843
Country : US
Telephone Number : 725-910-1846
Fax Number :
Provider Business Practice Location Address
First Line : 5136 N KIMBALL AVE APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60625-4843
Country : US
Telephone Number : 725-910-1846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2024
Last Update Date : 11/05/2024

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Directions to “ JASMINE PERNG ” Practice Location

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