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General NPI Number Information
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NPI Number | 1588643696
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Entity Type | Individual
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Provider Name | SU K JIN DDS
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 3901 MAIN ST SUITE #303
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City | FLUSHING
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State | NY
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Zip | 11354-5432
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Country | US
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Telephone | 718-359-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 20927 35TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-1451
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Country | US
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Telephone | 917-650-3735
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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 | 048441
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License Number State | NY
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