Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 64980 | CA |
NPI | 1003286519 |
---|---|
Provider Name | Dr. Tian Jin |
First Address | Pasadena, CA 91101-1638 |
Second Address | Pasadena, CA 91101-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2015 |
Last Update Date | 12/08/2019 |