=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548226103
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BYUNG MINN JINN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2006
-----------------------------------------------------
Last Update Date | 04/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12395 MCCRACKEN RD UNIT A-UP & D
-----------------------------------------------------
City | GARFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-587-6727
-----------------------------------------------------
Fax | 216-587-8347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12395 MCCRACKEN RD UNIT A-UP & D
-----------------------------------------------------
City | GARFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-2967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-587-6727
-----------------------------------------------------
Fax | 216-587-8347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 35034483J
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------