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General NPI Number Information
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NPI Number | 1750869491
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Entity Type | Individual
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Provider Name | JINSHAN JIN
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Gender | Female
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 1903 SUNSET AVE # 3
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City | UTICA
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State | NY
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Zip | 13502-5617
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Country | US
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Telephone | 315-797-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 2209 GENESEE STREET BUSINESS OFFICE ROOM 310
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City | UTICA
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State | NY
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Zip | 13501-5930
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Country | US
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Telephone | 315-801-3282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 022394
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License Number State | NY
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