Healthcare Provider Details

I. General information

NPI: 1972833796
Provider Name (Legal Business Name): JENNIFER CAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST FL 16
CHICAGO IL
60611-2987
US

IV. Provider business mailing address

254 2ND AVE STE 100
NEEDHAM MA
02494-2829
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5620
  • Fax: 312-695-7095
Mailing address:
  • Phone: 312-695-5620
  • Fax: 312-695-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number262657
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: