Active NPI
Zachary J Jin, DMD
- Dentist
- Jacksonville, FL
National Provider Identifier
1124574769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN21958
- Practice address
- 554 Keily Street
Bureau of Med and Surg Credentialing and Privilegeing
Jacksonville, FL 32212 - Phone
- (757) 953-1897
- NPI assigned
- Sep 1, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN21958 | FL | Primary |
Addresses
Primary practice location
554 Keily Street
Bureau of Med and Surg Credentialing and Privilegeing
Jacksonville, FL 32212
Mailing address
554 Keily Street
Bureau of Med and Surg Credentialing and Privilegeing
Jacksonville, FL 32212
Phone (757) 953-1897
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN21958 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1124574769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "554 KEILY STREET",
"address_2": "BUREAU OF MED AND SURG CREDENTIALING AND PRIVILEGEING",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32212",
"telephone_number": "757-953-1897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "554 KEILY STREET",
"address_2": "BUREAU OF MED AND SURG CREDENTIALING AND PRIVILEGEING",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32212",
"telephone_number": "757-953-1897"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIN",
"first_name": "ZACHARY",
"middle_name": "J",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-01",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN21958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.