Healthcare Provider Details

I. General information

NPI: 1215900311
Provider Name (Legal Business Name): JAMES OU JIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MEMORIAL DR STE 100
SOUTH BEND IN
46601-1063
US

IV. Provider business mailing address

PO BOX 2968
ELKHART IN
46515-2968
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1100
  • Fax: 574-647-3148
Mailing address:
  • Phone: 574-296-3307
  • Fax: 574-296-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01061466A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: