Provider Demographics
NPI:1548238819
Name:JEN KIN, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:JEN KIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 E ATHERTON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3700
Mailing Address - Country:US
Mailing Address - Phone:562-961-0155
Mailing Address - Fax:562-961-0161
Practice Address - Street 1:4525 E ATHERTON ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3700
Practice Address - Country:US
Practice Address - Phone:562-961-0155
Practice Address - Fax:562-961-0161
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA289822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50093Medicare UPIN
CAWA28982AMedicare ID - Type Unspecified