Doreva R Kinlaw, ESTHETICIAN

Primary specialty

SpecialistTaxonomy code 174400000X

License

AEE-23-00186 Issued in NY

Practice address

598 Grand Concourse
2ND FL
Bronx, NY 10451-1706

Phone

(347) 928-2175

NPI assigned

May 15, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• KKTM Testing LLC

  • Phlebotomy Technician
  • Bronx, NY
  • NPI 1063295186
  NPD Authorized official

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1407546237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "598 GRAND CONCOURSE",
            "address_2": "2ND FL",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104511706",
            "telephone_number": "347-928-2175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "598 GRAND CONCOURSE",
            "address_2": "2ND FL",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104511706",
            "telephone_number": "347-928-2175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINLAW",
        "first_name": "DOREVA",
        "middle_name": "R",
        "credential": "ESTHETICIAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "AEE-23-00186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kingscross Children Therapy and Autism Services
• Nunichu B Kingsley, LPN,RN
• Kingsway Med LLC
• Jyoti Kini, MD
• Milan Kinkhabwala, MD
• Merritt Drew Kinon, MD
• Aisha Kinshasa-Thomas, LPN
• PA Kinteh
• Timothy Kintzel, MD
• Khatuna Kipiani, NP

• Specialist in Bronx, NY
• Providers in Bronx, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.