Provider Demographics
NPI:1790574762
Name:JIN, CHAN YOUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAN YOUNG
Middle Name:
Last Name:JIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-0737
Mailing Address - Country:US
Mailing Address - Phone:318-308-0778
Mailing Address - Fax:
Practice Address - Street 1:25501 BRAINARD AVE, FORT EISENHOWER
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:318-308-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1237731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice