Provider Demographics
NPI:1225085061
Name:JIN, HAI-OU LAURA (MD)
Entity Type:Individual
Prefix:
First Name:HAI-OU
Middle Name:LAURA
Last Name:JIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3825
Mailing Address - Country:US
Mailing Address - Phone:410-822-6005
Mailing Address - Fax:410-822-9253
Practice Address - Street 1:511 IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3825
Practice Address - Country:US
Practice Address - Phone:410-822-6005
Practice Address - Fax:410-822-9253
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD055485207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD470200000Medicaid
MDH10555Medicare UPIN
MD211N216GMedicare ID - Type Unspecified