Provider Demographics
NPI:1033970959
Name:JENNIFER SHIN DDS INC
Entity Type:Organization
Organization Name:JENNIFER SHIN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-810-1318
Mailing Address - Street 1:17024 CLARK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5700
Mailing Address - Country:US
Mailing Address - Phone:213-810-1318
Mailing Address - Fax:
Practice Address - Street 1:17024 CLARK AVE STE C
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5700
Practice Address - Country:US
Practice Address - Phone:213-810-1318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty