Provider Demographics
NPI:1013277268
Name:JIN, BYUNGHAK (MD)
Entity type:Individual
Prefix:
First Name:BYUNGHAK
Middle Name:
Last Name:JIN
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 1:169 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8082
Mailing Address - Country:US
Mailing Address - Phone:724-627-4696
Mailing Address - Fax:724-627-4280
Practice Address - Street 1:169 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8082
Practice Address - Country:US
Practice Address - Phone:724-627-4696
Practice Address - Fax:724-627-4280
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032689L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB39906Medicare UPIN