Healthcare Provider Details

I. General information

NPI: 1700293107
Provider Name (Legal Business Name): SARAH JIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JIN FNP-C

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date: 09/10/2022
Reactivation Date: 10/03/2022

III. Provider practice location address

8205 W WARM SPRINGS RD STE 210
LAS VEGAS NV
89113-3646
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-534-5464
  • Fax: 702-534-5465
Mailing address:
  • Phone: 702-216-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95035578
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022688
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number865462
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: