MEDICARE: HO JU JIN D.D.S.

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	53913	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225274392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HO JU JIN D.D.S.

Provider Business Mailing Address
First Line	:	4007 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3401
Country	:	US
Telephone Number	:	213-385-1325
Fax Number	:	213-380-9842

Provider Business Practice Location Address
First Line	:	4007 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3401
Country	:	US
Telephone Number	:	213-385-1325
Fax Number	:	213-380-9842

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

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	05/23/2012

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Directions to “ HO JU JIN D.D.S.” Practice Location

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