Provider Demographics
NPI:1619366531
Name:KINJO, COLIN
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:KINJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 S LOS ALTOS PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-2500
Mailing Address - Country:US
Mailing Address - Phone:775-359-2020
Mailing Address - Fax:775-359-2676
Practice Address - Street 1:5961 S LOS ALTOS PKWY
Practice Address - Street 2:STE 101
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-2500
Practice Address - Country:US
Practice Address - Phone:775-359-2020
Practice Address - Fax:775-359-2676
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV110909Medicare PIN
NVV37415Medicare PIN