Provider Demographics
NPI:1629125380
Name:RA, JIN HEE (MD)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:HEE
Last Name:RA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP SURGERY DEPARTMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP SURGERY DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1015
Practice Address - Fax:904-244-4079
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT179830208600000X
FLME1076402086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581826893AMedicaid
FL0024329-00Medicaid
FLEG092ZMedicare PIN