Kenan Qin, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01071421A Issued in IN

Practice address

1160 Joliet St
Suite 103
Dyer, IN 46311-2096

Phone

(219) 322-8534

Fax

(219) 865-9072

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: drkenanqin@kidsfirst.opdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tae'Ni Chang-Stroman M.D., P.C.

  • Pediatrics Physician
  • Dyer, IN
  • NPI 1255487138
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430784000000",
    "number": "1679623615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 JOLIET ST",
            "address_2": "SUITE 103",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463112096",
            "telephone_number": "219-322-8534",
            "fax_number": "219-865-9072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 JOLIET ST",
            "address_2": "SUITE 103",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463112096",
            "telephone_number": "219-322-8534",
            "fax_number": "219-865-9072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QIN",
        "first_name": "KENAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2015-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "IN",
            "license": "01071421A",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01071421A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TAX ID",
            "identifier": "32-0149967",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036106209",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Alan Polich, N.P.
• Amber Poortenga
• Premier Adult Day Service
• Cathy J Puch, MA CCC SLP
• Angela M Purcell
• Madalyn Qualizza, PA-C
• Peggy A Quinn, LCSW
• Raby Home Healthcare,Inc
• Maaz A Raheem, DPM
• Gowri Ramadas, M.D.

• Pediatrics Physician in Dyer, IN
• Providers in Dyer, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.