Active NPI
Jinna Yun Ji Im, DMD
- Dentist
- Phoenix, AZ
National Provider Identifier
1477282291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D011408
- Practice address
- 742 E Glendale Ave Ste 118
Phoenix, AZ 85020-5352 - Phone
- (602) 491-0887
- NPI assigned
- Jun 7, 2022
- Last updated
- Jun 7, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D011408 | AZ | Primary |
Addresses
Primary practice location
742 E Glendale Ave Ste 118
Phoenix, AZ 85020-5352
Mailing address
2150 W Alameda Rd Unit 1169
Phoenix, AZ 85085-1951
Phone (808) 383-0209
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D011408 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Camelback Smiles Dentistry, LLP | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654560000000",
"number": "1477282291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2150 W ALAMEDA RD UNIT 1169",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850851951",
"telephone_number": "808-383-0209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "742 E GLENDALE AVE STE 118",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850205352",
"telephone_number": "602-491-0887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "JINNA",
"middle_name": "YUN JI",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-07",
"last_updated": "2022-06-07",
"certification_date": "2022-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D011408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.