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General NPI Number Information
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NPI Number | 1124481270
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Entity Type | Individual
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Provider Name | JASON L PENG MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST STE 7-701
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-695-7950
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Fax | 312-926-4771
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Provider Business Mailing Address
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Address Line | 251 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-3055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036149345
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036149345
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036149345
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 036149345
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License Number State | IL
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