Kelly Jin, D.M.D., Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

3739 Issued in NV

Legal business name

KELLY JIN, D.M.D., INC.

Doing business as

Icon Dental

Practice address

3730 E. Flamingo Rd.
Las Vegas, NV 89121

Phone

(702) 804-4266

Fax

(702) 435-1222

NPI assigned

Aug 20, 2009

Last updated

Aug 20, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly S. Jin, DMD

Title

Dentist/Owner

Phone

(702) 804-4266

Specialties & licenses 1

Addresses

Other names 1

• Icon Dental Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1033341342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 ARROYO CROSSING PARKWAY",
            "address_2": "#100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89113",
            "telephone_number": "702-880-4266",
            "fax_number": "702-792-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 E. FLAMINGO RD.",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89121",
            "telephone_number": "702-804-4266",
            "fax_number": "702-435-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY JIN, D.M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-20",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "JIN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "702-804-4266",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NV",
            "license": "3739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Icon Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Kellogg, RPH
• Lori Lynn Kellogg, MD
• Mackenzie Kellogg
• Raymond Vincent Kellogg, O.D.
• Ashley Kellough
• Kelly Murie PLLC (MaxHealth Center)
• Kelly Ophthalmology PC (Silver State Eye Care)
• Jeannettea Kelly-Webster
• Amantha(Mandy) Frances Kelly, LMT
• Amber Renee Kelly

• Dentist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.