Provider Demographics
NPI:1679510812
Name:CHAO, JASMINE (DO)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:CHAO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1308 WAUKEGAN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3070
Mailing Address - Country:US
Mailing Address - Phone:847-657-8588
Mailing Address - Fax:847-657-8778
Practice Address - Street 1:1308 WAUKEGAN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3070
Practice Address - Country:US
Practice Address - Phone:847-657-8588
Practice Address - Fax:847-657-8778
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107878207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03610787801Medicaid
IL0361078781Medicaid
IL03610787801Medicaid
IL0361078781Medicaid