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General NPI Number Information
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NPI Number | 1346256245
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Entity Type | Individual
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Provider Name | KOUROSH DINI MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1020 S WABASH AVE APT 4G
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City | CHICAGO
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State | IL
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Zip | 60605-2255
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Country | US
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Telephone | 312-391-3171
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 S WABASH AVE APT 4G
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City | CHICAGO
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State | IL
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Zip | 60605-2255
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Country | US
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Telephone | 312-391-3171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036107898
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 036107898
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License Number State | IL
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