Provider Demographics
NPI:1730338567
Name:KIM, JINSANG (DDS, MA)
Entity type:Individual
Prefix:DR
First Name:JINSANG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 BROAD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1631
Mailing Address - Country:US
Mailing Address - Phone:201-840-1123
Mailing Address - Fax:201-840-5699
Practice Address - Street 1:669 BROAD AVE STE 102
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1631
Practice Address - Country:US
Practice Address - Phone:201-840-1123
Practice Address - Fax:201-840-5699
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI194371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics