Provider Demographics
NPI:1588825418
Name:KIM, JIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:KIM
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 1:2709 PIEDMONT AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1397
Mailing Address - Country:US
Mailing Address - Phone:661-857-7662
Mailing Address - Fax:661-450-3662
Practice Address - Street 1:23922 SUMMERHILL LN
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354
Practice Address - Country:US
Practice Address - Phone:818-550-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100471223G0001X
TX245131223G0001X
CA608841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice