Chen, Jackson W
Chen, Jackson W is an sole proprietor health care provider with primary practice located at 209 Indian Trail Rd , Oak Brook IL 60523-2797. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Chen, Jackson W can be contacted via phone (760) 717-1412.Contact Information
Primary practice address
209 Indian Trail Rd
Oak Brook IL 60523-2797
Phone: (760) 717-1412
Fax: (760) 918-0960
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 036-047434 | Illinois |
Allopathic & Osteopathic Physicians / General Practice | 208D00000X | C50725 | California |
Profile Details
NPI number | 1316113954 |
---|---|
LBN Legal business name | Chen, Jackson W |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | May 4th, 2008 |
Last updated | May 6th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1316113954 | NPPES |
Illinois | Other | 0021606157 | BLUE CROSS BLUE SHIELD OF ILLINOIS |
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