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General NPI Number Information
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NPI Number | 1730299652
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Entity Type | Organization
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Legal Business Name | BALANCED LIFE SC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1650 MOON LAKE BLVD ATTN: DR JIN
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60194-1010
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Country | US
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Telephone | 947-496-4216
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Fax | 847-358-7516
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Provider Business Mailing Address
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Address Line | PO BOX 946
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City | STREAMWOOD
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State | IL
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Zip | 60107-3305
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Country | US
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Telephone | 630-497-1730
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Fax | 630-497-1379
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KWAN BO JIN
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Credential | MD
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Telephone | 847-496-4216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IL
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