Healthcare Provider Details

I. General information

NPI: 1124481270
Provider Name (Legal Business Name): JASON L PENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 7-701
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

251 E HURON ST
CHICAGO IL
60611-3055
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7950
  • Fax: 312-926-4771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036149345
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036149345
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036149345
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036149345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: