Jinju Song DMD PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DE60300517 Issued in WA

Legal business name

JINJU SONG DMD PLLC

Practice address

9707 NE 119TH Way
Kirkland, WA 98034-8955

Phone

(425) 310-8338

Fax

(425) 449-5933

NPI assigned

Jun 8, 2018

Organization subpart

No

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

Authorized official

Name

Jinju Song, DMD

Title

Owner/Doctor

Phone

(425) 310-8338

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Juanita Kids Dentistry Doing business as

Locations

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1497248017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9707 NE 119TH WAY",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980348955",
            "telephone_number": "425-310-8338",
            "fax_number": "425-449-5933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9707 NE 119TH WAY",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980348955",
            "telephone_number": "425-310-8338",
            "fax_number": "425-449-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JINJU SONG DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-08",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "JINJU",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "425-310-8338",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE60300517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1255644316",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "DE60300517",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Juanita Kids Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Juanita Kids Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taisia Alexandra Jignea, ARNP
• Stephanie Anne Jimmerson
• Jin Y Kim DDS, PS
• Wenzhen Jin, PH.D., L.AC.
• Judith Jindra, MED, LMFT
• Elisee Jionang Dapeu
• JJ Wellness LLC
• JMS Anesthesia LLC
• Modou Jobe
• Beatrice Joe, LMFT

• Pediatric Dentistry in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; 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.