Provider Demographics
NPI:1669739777
Name:AMON, JIN S (MD)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:S
Last Name:AMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JIN
Other - Middle Name:Z
Other - Last Name:SHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:2211 MAYFAIR DR
Practice Address - Street 2:SUITE 409
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4568
Practice Address - Country:US
Practice Address - Phone:270-417-7980
Practice Address - Fax:270-417-7989
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY492492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201392390Medicaid
KY7100249910Medicaid
KYK209250Medicare PIN