Healthcare Provider Details

I. General information

NPI: 1770076697
Provider Name (Legal Business Name): HELEN SHARON JIN MD MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 21ST ST
LONG ISLAND CITY NY
11106-4705
US

IV. Provider business mailing address

44 W 28TH ST FL 5
NEW YORK NY
10001-4212
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number315583
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number276089
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: