MEDICARE: JIM JIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	ME162222	FL

General Provider Information

NPI Number	:	1942823398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM JIN MD

Provider Business Mailing Address
First Line	:	1583 E SILVER STAR RD
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2553
Country	:	US
Telephone Number	:	407-770-1414
Fax Number	:	407-447-8876

Provider Business Practice Location Address
First Line	:	1583 E SILVER STAR RD
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2553
Country	:	US
Telephone Number	:	407-770-1414
Fax Number	:	407-447-8876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	04/10/2026

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