Provider Demographics
NPI:1942823398
Name:JIN, JIM (MD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9743 SELTEN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7933
Mailing Address - Country:US
Mailing Address - Phone:407-736-8733
Mailing Address - Fax:888-974-1815
Practice Address - Street 1:9743 SELTEN WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7933
Practice Address - Country:US
Practice Address - Phone:407-736-8733
Practice Address - Fax:888-974-1815
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162222208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program