Provider Demographics
NPI:1235109356
Name:DAHLIN, GINA SEJIN (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:SEJIN
Last Name:DAHLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 W 77TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5038
Mailing Address - Country:US
Mailing Address - Phone:952-567-7400
Mailing Address - Fax:952-852-2356
Practice Address - Street 1:777 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1522
Practice Address - Country:US
Practice Address - Phone:952-484-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9956363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970002433Medicare PIN