Provider Demographics
NPI:1245445519
Name:JIN, BYUNGWOO
Entity type:Individual
Prefix:DR
First Name:BYUNGWOO
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1630 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3713
Mailing Address - Country:US
Mailing Address - Phone:415-346-2828
Mailing Address - Fax:415-346-2896
Practice Address - Street 1:1630 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3713
Practice Address - Country:US
Practice Address - Phone:415-346-2828
Practice Address - Fax:415-346-2896
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB39660122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice