Provider Demographics
NPI:1972985588
Name:MASAKI, JAYSON TAKEJI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:TAKEJI
Last Name:MASAKI
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 1:1747 W. ROOSEVELT ROAD M/C 747
Mailing Address - Street 2:IJR 153
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:312-413-8433
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1250665692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry