Individual
ETHAN JIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-9169
Mailing address
4145 WINTERBERRY RD, CUMMING, GA 30040-6167
(770) 530-2870
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
Primary
125.084194
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2024
Last updated
08/13/2024
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