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1730299652 NPI number — BALANCED LIFE SC

NPI Number: 1730299652
Health Care Provider/Practitioner: BALANCED LIFE SC

Information about “1730299652” NPI (BALANCED LIFE SC) exists in 1730299652 in HTML format HTML  |  1730299652 in plain Text format TXT  |  1730299652 in PDF (Portable Document Format) PDF  |  1730299652 in an XML format XML  formats.

NPI Number : 1730299652 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730299652",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BALANCED LIFE SC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 946",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STREAMWOOD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60107-3305",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-497-1730",
    "MailingAddressFaxNumber": "630-497-1379",
    "FirstLinePracticeLocationAddress": "1650 MOON LAKE BLVD",
    "SecondLinePracticeLocationAddress": "ATTN: DR JIN",
    "PracticeLocationAddressCityName": "HOFFMAN ESTATES",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60194-1010",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "947-496-4216",
    "PracticeLocationAddressFaxNumber": "847-358-7516",
    "EnumerationDate": "08/30/2006",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JIN",
    "AuthorizedOfficialFirstName": "KWAN BO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "847-496-4216",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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