MEDICARE: DR. DAVID JIN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	047558-1	NY
2	1223G0001X	General Practice Dentistry	22DI02183600	NJ
3	122300000X	Dentist	22DI02183600	NJ

General Provider Information

NPI Number	:	1255334165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JIN D.D.S.

Provider Business Mailing Address
First Line	:	1315 ANDERSON AVE STE A
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1732
Country	:	US
Telephone Number	:	201-224-4400
Fax Number	:	201-224-4418

Provider Business Practice Location Address
First Line	:	1315 ANDERSON AVE STE A
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-1732
Country	:	US
Telephone Number	:	201-224-4400
Fax Number	:	201-224-4418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/23/2022

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