Healthcare Provider Details

I. General information

NPI: 1508310111
Provider Name (Legal Business Name): DONGKWAN JIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 N UNION BLVD STE 150
COLORADO SPRINGS CO
80907-1907
US

IV. Provider business mailing address

3920 N UNION BLVD STE 150
COLORADO SPRINGS CO
80907-1907
US

V. Phone/Fax

Practice location:
  • Phone: 719-694-3595
  • Fax: 719-439-9936
Mailing address:
  • Phone: 719-694-3595
  • Fax: 719-439-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0063888
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: