Provider Demographics
NPI:1912022542
Name:GIM, JASON SO YONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SO YONG
Last Name:GIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23838 VALENCIA BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5332
Mailing Address - Country:US
Mailing Address - Phone:661-254-1924
Mailing Address - Fax:661-254-1420
Practice Address - Street 1:23838 VALENCIA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5332
Practice Address - Country:US
Practice Address - Phone:661-254-1924
Practice Address - Fax:661-254-1420
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics