Individual
BAILAN JIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.N.
Contact information
Practice address
2165 S CHINA PL, SUITE B, CHICAGO, IL 60616-1536
(773) 386-2683
(312) 225-4047
Mailing address
2165 S CHINA PL, SUITE B, CHICAGO, IL 60616-1536
(773) 386-2683
(312) 225-4047
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
181-000303
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633495
BLUESHIELD PROVIDER NUMBE
IL
01
—
181-000303
LICENSE NUMBER
IL
Enumeration date
11/20/2006
Last updated
07/08/2007
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