Organization
BALANCED LIFE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KWAN BO JIN MD (PRESIDENT)
(847) 496-4216
Entity
Organization
Contact information
Practice address
1650 MOON LAKE BLVD, ATTN: DR JIN, HOFFMAN ESTATES, IL 60194-1010
(947) 496-4216
(847) 358-7516
Mailing address
PO BOX 946, STREAMWOOD, IL 60107-3305
(630) 497-1730
(630) 497-1379
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K14710
PROVIDER MEDICARE NUMBER
IL
01
—
K14711
PROVIDER MEDICARE NUMBER
IL
01
—
K14712
PROVIDER MEDICARE NUMBER
IL
Enumeration date
08/30/2006
Last updated
08/22/2020
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