Healthcare Provider Details

I. General information

NPI: 1437085362
Provider Name (Legal Business Name): JIN DAWSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE
MUNSTER IN
46321-4037
US

IV. Provider business mailing address

4600 SUNSET AVE
INDIANAPOLIS IN
46208-3443
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: