Provider Demographics
NPI:1467790097
Name:SHIN, JIN KYUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:KYUNG
Last Name:SHIN
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 1:25829 VAN LEUVEN ST APT 166
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2555
Mailing Address - Country:US
Mailing Address - Phone:909-580-0599
Mailing Address - Fax:
Practice Address - Street 1:25829 VAN LEUVEN ST APT 166
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2555
Practice Address - Country:US
Practice Address - Phone:909-580-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist