Healthcare Provider Details

I. General information

NPI: 1285098178
Provider Name (Legal Business Name): JESSICA TUAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

2147 KENTUCKY CT
WHEATON IL
60189-8963
US

V. Phone/Fax

Practice location:
  • Phone: 630-532-3325
  • Fax:
Mailing address:
  • Phone: 630-532-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number327779
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number69877
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: