Active NPI
Balanced Life SC
- Psychiatry Physician
- Hoffman Estates, IL
National Provider Identifier
1730299652
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(8) exclusion effective Dec 20, 2011.
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- BALANCED LIFE SC
- Practice address
- 1650 Moon Lake Blvd
Attn: Dr Jin
Hoffman Estates, IL 60194-1010 - Phone
- (947) 496-4216
- Fax
- (847) 358-7516
- NPI assigned
- Aug 30, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kwan Bo Jin, MD
- Title
- President
- Phone
- (847) 496-4216
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | IL | Primary |
Addresses
Primary practice location
1650 Moon Lake Blvd
Attn: Dr Jin
Hoffman Estates, IL 60194-1010
Mailing address
PO Box 946
Streamwood, IL 60107-3305
Phone (630) 497-1730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Psychiatry Physician
- Hoffman Estates, IL
- NPI 1376578039
-
- Psychiatry Physician
- Merrillville, IN
- NPI 1093738296
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1730299652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 946",
"city": "STREAMWOOD",
"state": "IL",
"postal_code": "601073305",
"telephone_number": "630-497-1730",
"fax_number": "630-497-1379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 MOON LAKE BLVD",
"address_2": "ATTN: DR JIN",
"city": "HOFFMAN ESTATES",
"state": "IL",
"postal_code": "601941010",
"telephone_number": "947-496-4216",
"fax_number": "847-358-7516"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BALANCED LIFE SC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-30",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "JIN",
"authorized_official_first_name": "KWAN BO",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "847-496-4216",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Hoffman Estates, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.