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General NPI Number Information
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NPI Number | 1033341342
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Entity Type | Organization
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Legal Business Name | KELLY JIN, D.M.D., INC.
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 3730 E. FLAMINGO RD.
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City | LAS VEGAS
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State | NV
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Zip | 89121
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Country | US
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Telephone | 702-804-4266
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Fax | 702-435-1222
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Provider Business Mailing Address
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Address Line | 7300 ARROYO CROSSING PARKWAY #100
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 702-880-4266
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Fax | 702-792-4266
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. KELLY S. JIN
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Credential | DMD
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Telephone | 702-804-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3739
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License Number State | NV
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