Provider Demographics
NPI:1700941416
Name:SHEN LING D.M.D. & JIN KIM D.D.S. INC
Entity type:Organization
Organization Name:SHEN LING D.M.D. & JIN KIM D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:YEOP
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDA MPH
Authorized Official - Phone:909-861-3043
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:909-861-3043
Practice Address - Fax:909-860-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty