Provider Demographics
NPI:1922032911
Name:BASHOUR, JENNIFER MIN-WEN YIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MIN-WEN YIN
Last Name:BASHOUR
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 1:400 W. IH 635
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:972-481-6363
Mailing Address - Fax:972-406-2732
Practice Address - Street 1:400 W. IH 635
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:972-481-6363
Practice Address - Fax:972-406-2732
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5985207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158442701Medicaid
TX8J0302OtherBCBS
TXP00028485Medicare PIN
TX8J0302OtherBCBS
H82898Medicare UPIN