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General NPI Number Information
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NPI Number | 1679623615
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Entity Type | Individual
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Provider Name | KENAN QIN MD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 1160 JOLIET ST SUITE 103
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City | DYER
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State | IN
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Zip | 46311-2096
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Country | US
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Telephone | 219-322-8534
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Fax | 219-865-9072
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Provider Business Mailing Address
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Address Line | 1160 JOLIET ST SUITE 103
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City | DYER
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State | IN
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Zip | 46311-2096
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Country | US
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Telephone | 219-322-8534
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Fax | 219-865-9072
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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 | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 01071421A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01071421A
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License Number State | IN
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