MEDICARE: DR. PENGFENG JACK JIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	27917	NV
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	LL4184	NV
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1528828282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENGFENG JACK JIN MD

Provider Business Mailing Address
First Line	:	6630 ARROYO SPRINGS ST STE 1200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1948
Country	:	US
Telephone Number	:	702-900-9888
Fax Number	:	888-316-6618

Provider Business Practice Location Address
First Line	:	5510 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7700
Country	:	US
Telephone Number	:	702-900-9888
Fax Number	:	888-316-6618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	12/16/2025

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