Active NPI
Chang Kon Jin, M.D.
- Hematology & Oncology Physician
- Anniston, AL
National Provider Identifier
1770504649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 00006505
- Practice address
- 1010 Christine Ave
Anniston, AL 36207-5710 - Phone
- (256) 236-5631
- Fax
- (256) 236-5637
- NPI assigned
- Jul 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 00006505 | AL | Primary |
Addresses
Primary practice location
1010 Christine Ave
Anniston, AL 36207-5710
Mailing address
PO Box 2127
Anniston, AL 36202-2127
Phone (256) 236-5631
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3610078 | Other | AL | UNITED HEALTHCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6505 | AL | MD | Dentist |
| 00006505 | AL | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208304000000",
"number": "1770504649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2127",
"city": "ANNISTON",
"state": "AL",
"postal_code": "362022127",
"telephone_number": "256-236-5631",
"fax_number": "256-236-5637"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 CHRISTINE AVE",
"city": "ANNISTON",
"state": "AL",
"postal_code": "362075710",
"telephone_number": "256-236-5631",
"fax_number": "256-236-5637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIN",
"first_name": "CHANG KON",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-23",
"last_updated": "2008-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "AL",
"license": "00006505",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "3610078",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anniston, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.