Provider Demographics
NPI:1730273343
Name:JEN KIN, LAURA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:JEN KIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 E LOS ANGELES AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:805-522-6020
Mailing Address - Fax:805-522-6432
Practice Address - Street 1:1720 E LOS ANGELES AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-522-6020
Practice Address - Fax:805-522-6432
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice