| Doctor Name: | JACKSON W CHEN |
| NPI Number: | 1316113954 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C50725 |
| Business Practice Address: | 209 Indian Trail Rd Oak Brook, IL - 605232797 |
| Business Phone Number: | 7607171412 |
| Business Fax Number: | 7609180960 |
| Mailing Address: | 209 Indian Trail Rd, OAK BROOK |
| State: | IL |
| Postal Code: | 605232797 |
| Phone Number: | 7607171412 |
| Fax Number: | 7609180960 |
| NPI Enumeration Date: | 05/04/2008 |
| NPI Last Update Date: | 05/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C50725 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |