Healthcare Provider Details

I. General information

NPI: 1871458976
Provider Name (Legal Business Name): TIFFANY WEN LING JAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

1639 YOSEMITE DR
MILPITAS CA
95035-6547
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: