Individual
JENNY TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3755 E MAIN ST, STE 190, ST CHARLES, IL 60174-2463
(630) 348-3100
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036101643
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101643
—
IL
Enumeration date
03/24/2006
Last updated
01/27/2011
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