{
"Npi": {
"NPI": "1033341342",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KELLY JIN, D.M.D., INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7300 ARROYO CROSSING PARKWAY",
"SecondLineMailingAddress": "#100",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89113",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-880-4266",
"MailingAddressFaxNumber": "702-792-4266",
"FirstLinePracticeLocationAddress": "3730 E. FLAMINGO RD.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89121",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-804-4266",
"PracticeLocationAddressFaxNumber": "702-435-1222",
"EnumerationDate": "08/20/2009",
"LastUpdateDate": "08/20/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JIN",
"AuthorizedOfficialFirstName": "KELLY",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "DENTIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD",
"AuthorizedOfficialTelephoneNumber": "702-804-4266",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "3739",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}