Provider Demographics
NPI:1447929583
Name:JIN MAI-SOTO DDS, PLLC
Entity type:Organization
Organization Name:JIN MAI-SOTO DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAI-SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-829-4981
Mailing Address - Street 1:1313 BALCOM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5801
Mailing Address - Country:US
Mailing Address - Phone:347-829-4981
Mailing Address - Fax:
Practice Address - Street 1:999 SUMMER ST STE 300
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5513
Practice Address - Country:US
Practice Address - Phone:347-829-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental