=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770366205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. JIN AND JIN DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2023
-----------------------------------------------------
Last Update Date | 08/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9201 S TOLEDO AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74137-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-3600
-----------------------------------------------------
Fax | 918-499-1730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14004 E 104TH ST N
-----------------------------------------------------
City | OWASSO
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74055-4594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-809-7992
-----------------------------------------------------
Fax | 918-499-1730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. LINFAN JIN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 918-749-3600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------