Provider Demographics
NPI:1992367247
Name:CHIN, KYLE MICHAEL
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MICHAEL
Last Name:CHIN
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 1:5 EXECUTIVE CT STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9534
Mailing Address - Country:US
Mailing Address - Phone:847-382-8889
Mailing Address - Fax:
Practice Address - Street 1:5 EXECUTIVE CT STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9534
Practice Address - Country:US
Practice Address - Phone:847-382-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-07
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist