Provider Demographics
NPI:1164100327
Name:MIN, IN JEONG (DDS)
Entity type:Individual
Prefix:DR
First Name:IN JEONG
Middle Name:
Last Name:MIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:IN
Other - Middle Name:J
Other - Last Name:MIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12826 SE 40TH LN STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4276
Mailing Address - Country:US
Mailing Address - Phone:425-641-5303
Mailing Address - Fax:
Practice Address - Street 1:12826 SE 40TH LN STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4276
Practice Address - Country:US
Practice Address - Phone:425-641-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA700259531223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program