Individual
JACKSON W CHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
209 INDIAN TRAIL RD, OAK BROOK, IL 60523-2797
(760) 717-1412
(760) 918-0960
Mailing address
209 INDIAN TRAIL RD, OAK BROOK, IL 60523-2797
(760) 717-1412
(760) 918-0960
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036-047434
IL
208D00000X
General Practice Physician
C50725
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021606157
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
05/04/2008
Last updated
05/06/2008
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