Provider Demographics
NPI:1013109719
Name:J. JIN EL-MALLAWANY, MD
Entity Type:Organization
Organization Name:J. JIN EL-MALLAWANY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-MALLAWANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-349-2999
Mailing Address - Street 1:34501 AURORA RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3873
Mailing Address - Country:US
Mailing Address - Phone:440-349-2999
Mailing Address - Fax:
Practice Address - Street 1:34501 AURORA RD
Practice Address - Street 2:STE 101
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-349-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0417112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000230441OtherANTHEM BLUE CROSS
OH0600040Medicaid
SP03941Medicare PIN