Provider Demographics
NPI:1891706933
Name:HEUR, JIN H (MD)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:H
Last Name:HEUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E CHEVY CHASE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4152
Mailing Address - Country:US
Mailing Address - Phone:818-246-7260
Mailing Address - Fax:818-502-9247
Practice Address - Street 1:1500 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4152
Practice Address - Country:US
Practice Address - Phone:818-246-7260
Practice Address - Fax:818-502-9247
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079889207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221406OtherUNISON
OH2332489Medicaid
OH7254348OtherAETNA
OH000000374506OtherANTHEM
OH2332489OtherBCMH
OH363635OtherWELLCARE
OH000000526061OtherANTHEM
OH745916OtherBUCKEYE
OH2332489Medicaid
OH000000221406OtherUNISON
OHHE4168741Medicare PIN