Provider Demographics
NPI:1396881041
Name:KIM, JIN Y (DDS, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:JIN
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N DIAMOND BAR BLVD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1037
Mailing Address - Country:US
Mailing Address - Phone:909-861-3043
Mailing Address - Fax:909-860-3263
Practice Address - Street 1:620 N DIAMOND BAR BLVD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1037
Practice Address - Country:US
Practice Address - Phone:909-860-9222
Practice Address - Fax:714-276-6116
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics