Provider Demographics
NPI:1164654877
Name:JIN, JINYOUNG SARAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JINYOUNG
Middle Name:SARAH
Last Name:JIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BROAD AVE
Mailing Address - Street 2:2FL
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1607
Mailing Address - Country:US
Mailing Address - Phone:201-592-0111
Mailing Address - Fax:201-592-0069
Practice Address - Street 1:535 BROAD AVE
Practice Address - Street 2:2FL
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1607
Practice Address - Country:US
Practice Address - Phone:201-592-0111
Practice Address - Fax:201-592-0069
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0545651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice