Provider Demographics
NPI:1033341342
Name:KELLY JIN, D.M.D., INC.
Entity type:Organization
Organization Name:KELLY JIN, D.M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-804-4266
Mailing Address - Street 1:7300 ARROYO CROSSING PARKWAY
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113
Mailing Address - Country:US
Mailing Address - Phone:702-880-4266
Mailing Address - Fax:702-792-4266
Practice Address - Street 1:3730 E. FLAMINGO RD.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-804-4266
Practice Address - Fax:702-435-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty