Provider Demographics
NPI:1700079217
Name:JUE, JIWON JANE SHIN (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:JIWON JANE
Middle Name:SHIN
Last Name:JUE
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:JIWON
Other - Middle Name:JANE
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3156 KENSINGTON AVE
Mailing Address - Street 2:ESPERANZA HEALTH CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3156 KENSINGTON AVE
Practice Address - Street 2:ESPERANZA HEALTH CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2400
Practice Address - Country:US
Practice Address - Phone:215-831-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine