Individual
FAWN JIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
10060 REGENCY CIR, OMAHA, NE 68114-3732
(402) 354-1580
(402) 354-1409
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
44764
CO
207R00000X
Internal Medicine Physician
Primary
716
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467557603
—
IA
05
—
47068731742
—
NE
Enumeration date
09/13/2006
Last updated
01/03/2014
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