Provider Demographics
NPI:1689904500
Name:JASMINE WANG CHAO, D.O., LTD.
Entity Type:Organization
Organization Name:JASMINE WANG CHAO, D.O., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-657-8588
Mailing Address - Street 1:PO BOX 1666
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-8666
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107878207Q00000X, 207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107878Medicaid
IL036107878Medicaid
IL206288Medicare UPIN