Provider Demographics
NPI:1851185920
Name:KIM, JINNU (DMD MS)
Entity type:Individual
Prefix:DR
First Name:JINNU
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W 34TH ST ADVANCED PERIODONTOLOGY RESIDENT ROOM 119
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0641
Mailing Address - Country:US
Mailing Address - Phone:213-740-2805
Mailing Address - Fax:
Practice Address - Street 1:925 W 34TH ST ADVANCED PERIODONTOLOGY RESIDENT ROOM 119
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0001
Practice Address - Country:US
Practice Address - Phone:213-740-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096431223P0300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223P0300XDental ProvidersDentistPeriodontics