Kelly S Jin, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

45360 Issued in CA

Practice address

6612 Silverspur LN
Huntington Beach, CA 92648-1503

Phone

(714) 342-0121

NPI assigned

Aug 15, 2019

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

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.

• Anthony Ngo, DMD Professional Corporation

  • Dental Clinic/Center
  • Huntington Beach, CA
  • NPI 1427658541
  NPD

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1477109353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6612 SILVERSPUR LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481503",
            "telephone_number": "714-342-0121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6612 SILVERSPUR LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481503",
            "telephone_number": "714-342-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIN",
        "first_name": "KELLY",
        "middle_name": "S",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-15",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "45360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jequinto Dental, Inc
• Alysia Jewett
• Juleny Jimenez
• Magali Jimenez
• Vanessa Jimenez
• Jillian Jinkins
• Anisha Jivraj, STUDENT
• JL Anesthesia, Inc.
• Yoonie Hyunjung Jo, FNP
• Joanna Leal

• General Practice Dentistry in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.