Individual
KENAN QIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 JOLIET ST, SUITE 103, DYER, IN 46311-2096
(219) 322-8534
(219) 865-9072
Mailing address
1160 JOLIET ST, SUITE 103, DYER, IN 46311-2096
(219) 322-8534
(219) 865-9072
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01071421A
IN
2080P0205X
Pediatric Endocrinology Physician
01071421A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036106209
—
IL
01
—
32-0149967
GROUP TAX ID
—
Enumeration date
01/11/2007
Last updated
05/05/2015
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