Healthcare Provider Details

I. General information

NPI: 1851211692
Provider Name (Legal Business Name): ARA JIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AHRA JIN

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 KETTNER BLVD APT 440
SAN DIEGO CA
92101-2264
US

IV. Provider business mailing address

1980 KETTNER BLVD APT 440
SAN DIEGO CA
92101-2264
US

V. Phone/Fax

Practice location:
  • Phone: 917-690-2486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95039873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: