Provider Demographics
NPI:1326155185
Name:JIN, BORA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BORA
Middle Name:
Last Name:JIN
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 1:3814 BRIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1571
Mailing Address - Country:US
Mailing Address - Phone:202-494-0656
Mailing Address - Fax:
Practice Address - Street 1:8703 STONEWALL RD
Practice Address - Street 2:SUITE 2-B
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8325
Practice Address - Country:US
Practice Address - Phone:703-361-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant