Provider Demographics
NPI:1922163021
Name:YOO, JINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JINA
Middle Name:
Last Name:YOO
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 1:4375 COBB PKWY SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5536
Mailing Address - Country:US
Mailing Address - Phone:770-541-9131
Mailing Address - Fax:770-541-9132
Practice Address - Street 1:4375 COBB PKWY SE
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5536
Practice Address - Country:US
Practice Address - Phone:770-541-9131
Practice Address - Fax:770-541-9132
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN013021OtherLICENSE
BYT7351252OtherDEA
DN013021OtherLICENSE