MEDICARE: CAROLINE JIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DDS108328	CA

General Provider Information

NPI Number	:	1174217939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE JIN

Provider Business Mailing Address
First Line	:	2528 S GRAND AVE APT 716
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4674
Country	:	US
Telephone Number	:	540-331-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	2528 S GRAND AVE APT 716
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4674
Country	:	US
Telephone Number	:	540-331-1180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	04/14/2026

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Directions to “ CAROLINE JIN ” Practice Location

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