Provider Demographics
NPI:1508126798
Name:JIN, DAN (L AC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 41ST AVE
Mailing Address - Street 2:#3A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4917
Mailing Address - Country:US
Mailing Address - Phone:347-977-6308
Mailing Address - Fax:
Practice Address - Street 1:15015 41ST AVE
Practice Address - Street 2:#3A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4917
Practice Address - Country:US
Practice Address - Phone:347-977-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00089600171100000X
NY004670171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist