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General NPI Number Information
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NPI Number | 1174217939
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Entity Type | Individual
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Provider Name | CAROLINE JIN
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 2805 S SAN PEDRO ST
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City | LOS ANGELES
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State | CA
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Zip | 90011-2023
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Country | US
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Telephone | 540-331-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 2528 S GRAND AVE APT 716
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City | LOS ANGELES
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State | CA
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Zip | 90007-4674
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Country | US
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Telephone | 540-331-1180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS108328
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License Number State | CA
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