David Jin, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02183600 Issued in NJ

Practice address

1315 Anderson Ave Ste a
Fort Lee, NJ 07024-1732

Phone

(201) 224-4400

Fax

(201) 224-4418

NPI assigned

May 24, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, MA, NY3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

DentistAlso: Oral Surgery

Education

New York University College of Dentistry, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Snore No More by Abs LLC

  • Multi-Specialty Clinic/Center
  • Fair Lawn, NJ
  • NPI 1508583402

  Dentist

  Medicare reassignment NPD Authorized official
• A Beautiful Smile Dentistry LLC

  • Dental Clinic/Center
  • West Roxbury, MA
  • NPI 1568832673
  Medicare reassignment NPD Authorized official
• Snore No More Ny

  • Oral and Maxillofacial Surgery (Dentist)
  • Flushing, NY
  • NPI 1487447298
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666483200000",
    "number": "1255334165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 ANDERSON AVE STE A",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070241732",
            "telephone_number": "201-224-4400",
            "fax_number": "201-224-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 ANDERSON AVE STE A",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070241732",
            "telephone_number": "201-224-4400",
            "fax_number": "201-224-4418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1864 Centre St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021321919",
            "country_code": "US",
            "telephone_number": "617-390-5371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JIN",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2022-10-23",
        "certification_date": "2022-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "047558-1",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02183600",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02183600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathane Soo Jeon, D.D.S.
• Sooyeon Jeong
• Louis Jerome, DMD
• Jersey Stake LLC
• Jigsaw Diagnostics New Jersey PC
• SE Min Jin
• JK Nephrology and Hypertension LLC
• Joel D Singer DMD
• John Kim MD Med & Geriatrics, LLC
• John T. Miele, PH.D.

• Dentist in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.