Basic Information
Provider Information
NPI: 1124289665
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OH
FirstName: JINNY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 37018 22ND AVE S
Address2:  
City: FEDERAL WAY
State: WA
PostalCode: 980037585
CountryCode: US
TelephoneNumber: 2063491289
FaxNumber:  
Practice Location
Address1: 955 POWELL AVE SW
Address2: SUITE A
City: RENTON
State: WA
PostalCode: 980572908
CountryCode: US
TelephoneNumber: 4252030432
FaxNumber: 4252771566
Other Information
ProviderEnumerationDate: 06/18/2008
LastUpdateDate: 06/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN00177296WAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


Home