Provider Demographics
NPI:1114043635
Name:JIN, YOUNG K (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:K
Last Name:JIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2102
Mailing Address - Country:US
Mailing Address - Phone:513-321-2465
Mailing Address - Fax:513-769-6909
Practice Address - Street 1:3440 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2102
Practice Address - Country:US
Practice Address - Phone:513-321-2465
Practice Address - Fax:513-769-6909
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice