Jin Y Kim, DDS, MPH, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

41267 Issued in CA

Practice address

620 N Diamond Bar Blvd
Diamond Bar, CA 91765-1037

Phone

(909) 860-9222

Fax

(714) 276-6116

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shen Ling D.M.D. & Jin Kim D.D.S. Inc

  • Periodontics
  • Diamond Bar, CA
  • NPI 1700941416
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1396881041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N DIAMOND BAR BLVD",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651037",
            "telephone_number": "909-861-3043",
            "fax_number": "909-860-3263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N DIAMOND BAR BLVD",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917651037",
            "telephone_number": "909-860-9222",
            "fax_number": "714-276-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JIN",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "DDS, MPH, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "41267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elaine Kim
• Hyosu Kim
• Hyung Ah Kim
• James Eui Dong Kim, RN
• Jeunghoan Kim, FNP-C
• Jin Young Kim, D.D.S.
• Jong Guhn Kim, M.D.,
• June Kim, ACUPUNCTURIST
• Jung Hyun Kim
• Keun Chul Kim

• Periodontics in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.