Provider Demographics
NPI:1376578039
Name:JIN, KWAN BO (MD)
Entity Type:Individual
Prefix:
First Name:KWAN
Middle Name:BO
Last Name:JIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-0946
Mailing Address - Country:US
Mailing Address - Phone:630-497-1730
Mailing Address - Fax:630-497-1379
Practice Address - Street 1:1650 MOON LAKE BLVD
Practice Address - Street 2:ATT: DR JIN
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1010
Practice Address - Country:US
Practice Address - Phone:847-882-1600
Practice Address - Fax:847-358-7516
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry