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NPI Code Detail

MEDICARE: DR. PENGFENG JACK JIN MD

MEDICARE: DR. PENGFENG JACK JIN MD
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
1207RG0300XGeriatric Medicine (Internal Medicine) PhysicianLL4184NV
2390200000XStudent in an Organized Health Care Education/Training Program
3207RG0300XGeriatric Medicine (Internal Medicine) Physician27917NV

General Provider Information

NPI Number : 1528828282
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PENGFENG JACK JIN MD
Provider Business Mailing Address
First Line : 5599 ROLLINS ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-6050
Country : US
Telephone Number : 725-325-4848
Fax Number : 888-316-6618
Provider Business Practice Location Address
First Line : 8905 W POST RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2429
Country : US
Telephone Number : 725-325-4848
Fax Number : 888-316-6618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2024
Last Update Date : 05/26/2026

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