Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 01080635A | IN |
NPI | 1356605299 |
---|---|
Provider Name | Jay Jun-Hong Jin |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300016337 | (05) | IN |
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |