Provider Demographics
NPI:1518315241
Name:JIN, KINSLEY
Entity Type:Individual
Prefix:DR
First Name:KINSLEY
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 OGDEN AVENUE
Mailing Address - Street 2:330
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RUSH-COPLEY FAMILY MEDICINE CENTER 2020 OGDEN AVENUE
Practice Address - Street 2:SUITE 330
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-978-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125068617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine