Provider Demographics
NPI:1487865747
Name:JOE, JINHO (DDS)
Entity Type:Individual
Prefix:
First Name:JINHO
Middle Name:
Last Name:JOE
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 1:11658 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6720
Mailing Address - Country:US
Mailing Address - Phone:951-676-8920
Mailing Address - Fax:951-676-8976
Practice Address - Street 1:16200 BEAR VALLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8708
Practice Address - Country:US
Practice Address - Phone:760-952-2102
Practice Address - Fax:760-952-2953
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice