Provider Demographics
NPI:1023809167
Name:JIN, KANGSUN (CRNP)
Entity type:Individual
Prefix:
First Name:KANGSUN
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BRADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1034
Mailing Address - Country:US
Mailing Address - Phone:929-395-6116
Mailing Address - Fax:
Practice Address - Street 1:793 OLD ROUTE 119 HWY N
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1372
Practice Address - Country:US
Practice Address - Phone:888-686-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033087363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health