MEDICARE: JASON TSAI CHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A76587	CA
2	207R00000X	Internal Medicine Physician	036126956	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036.126956	OTHER	IL	ILLINOIS MEDICAL LICENSE NUMBER
2	A76587	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1972543239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON TSAI CHEN MD

Provider Business Mailing Address
First Line	:	1000 VILLAGE CENTER DR UNIT 204
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-4540
Country	:	US
Telephone Number	:
Fax Number	:	773-768-6141

Provider Business Practice Location Address
First Line	:	8012 S CRANDON AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:	773-356-5415
Fax Number	:	773-768-6141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/24/2024

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Directions to “ JASON TSAI CHEN MD” Practice Location

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