Provider Demographics
NPI:1053959536
Name:JIN, YING (NP)
Entity type:Individual
Prefix:
First Name:YING
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BRYN DU DR
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1512
Mailing Address - Country:US
Mailing Address - Phone:786-493-3950
Mailing Address - Fax:
Practice Address - Street 1:5700 KARL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3602
Practice Address - Country:US
Practice Address - Phone:614-846-5420
Practice Address - Fax:614-438-5873
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0029477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA145513Medicaid