Healthcare Provider Details

I. General information

NPI: 1932161684
Provider Name (Legal Business Name): WEIMIN JIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MAIN ST
ROCKAWAY NJ
07866-3614
US

IV. Provider business mailing address

4750 TASSAJARA RD #5321
DUBLIN CA
94568-4565
US

V. Phone/Fax

Practice location:
  • Phone: 973-784-4749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number55494
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22171
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: