Healthcare Provider Details

I. General information

NPI: 1437141322
Provider Name (Legal Business Name): JASEN C CHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SHACKLEFORD DR
LITTLE ROCK AR
72211-2858
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-500-5001
  • Fax: 501-500-5008
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberE3762
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: