Individual
DR. KOUROSH DINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 S WABASH AVE APT 4G, CHICAGO, IL 60605-2255
(312) 391-3171
Mailing address
1020 S WABASH AVE APT 4G, CHICAGO, IL 60605-2255
(312) 391-3171
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
—
IL
2084P0800X
Psychiatry Physician
036107898
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036107898
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635637
BC/BS
—
05
—
036107898
—
IL
Enumeration date
07/31/2006
Last updated
12/03/2024
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