Provider Demographics
NPI:1750608485
Name:GIN, JANE LEE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:LEE
Last Name:GIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:SOYOUN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3628 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2643
Mailing Address - Country:US
Mailing Address - Phone:310-900-5010
Mailing Address - Fax:310-900-5019
Practice Address - Street 1:3628 E IMPERIAL HWY
Practice Address - Street 2:SUITE 408
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2643
Practice Address - Country:US
Practice Address - Phone:310-900-5010
Practice Address - Fax:310-900-5019
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143322208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery