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:
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Health care specialties

SpecialtyCodeLicense #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 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316113954 NPPES
Illinois Other 0021606157 BLUE CROSS BLUE SHIELD OF ILLINOIS

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