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General NPI Number Information
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NPI Number | 1477282291
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Entity Type | Individual
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Provider Name | JINNA YUN JI IM DMD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 742 E GLENDALE AVE STE 118
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City | PHOENIX
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State | AZ
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Zip | 85020-5352
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Country | US
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Telephone | 602-491-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 W ALAMEDA RD UNIT 1169
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City | PHOENIX
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State | AZ
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Zip | 85085-1951
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Country | US
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Telephone | 808-383-0209
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D011408
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License Number State | AZ
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