Provider Demographics
NPI:1508147638
Name:JIN, CHANGHEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANGHEE
Middle Name:
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 1:512 PALM CIRCLE, BUILDING T118
Mailing Address - Street 2:
Mailing Address - City:FT. SHAFTER
Mailing Address - State:HI
Mailing Address - Zip Code:96858
Mailing Address - Country:US
Mailing Address - Phone:808-787-0184
Mailing Address - Fax:
Practice Address - Street 1:512 PALM CIRCLE, BUILDING T118
Practice Address - Street 2:
Practice Address - City:FT. SHAFTER
Practice Address - State:HI
Practice Address - Zip Code:96858
Practice Address - Country:US
Practice Address - Phone:808-787-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9029122300000X
KY11441223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist