Individual
DIANA JIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
4323 TACOMA TRCE, SUWANEE, GA 30024-8731
(626) 246-2429
Mailing address
4323 TACOMA TRCE, SUWANEE, GA 30024-8731
(626) 246-2429
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DE60865949
WA
122300000X
Dentist
Primary
DN122784
GA
1223D0001X
Public Health Dentistry
DE60865949
WA
1223G0001X
General Practice Dentistry
65134
CA
Other
Enumeration date
12/05/2015
Last updated
12/13/2022
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