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General NPI Number Information
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NPI Number | 1326226101
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Entity Type | Organization
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Legal Business Name | JINHO JOE. DDS.INC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 16200 BEAR VALLEY RD STE 105
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City | VICTORVILLE
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State | CA
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Zip | 92395-8708
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Country | US
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Telephone | 760-952-2102
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Fax | 760-952-2953
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Provider Business Mailing Address
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Address Line | 11658 LAUREL AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-6720
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Country | US
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Telephone | 909-799-5917
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JINHO JOE
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Credential | DDS
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Telephone | 909-799-5917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 52066
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License Number State | CA
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