Provider Demographics
NPI:1437141322
Name:CHI, JASEN C (MD)
Entity Type:Individual
Prefix:
First Name:JASEN
Middle Name:C
Last Name:CHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHACKLEFORD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2858
Mailing Address - Country:US
Mailing Address - Phone:501-500-5001
Mailing Address - Fax:
Practice Address - Street 1:6 SHACKLEFORD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2858
Practice Address - Country:US
Practice Address - Phone:501-500-5001
Practice Address - Fax:501-500-5008
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3762207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157630001Medicaid
AR5N256Medicare ID - Type Unspecified
AR0465700001Medicare NSC