Provider Demographics
NPI:1053314476
Name:LI-YEN LIN DDS PA
Entity type:Organization
Organization Name:LI-YEN LIN DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIYEN
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-595-2505
Mailing Address - Street 1:17320 W GRAND PKWY S STE B
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2667
Mailing Address - Country:US
Mailing Address - Phone:832-595-2505
Mailing Address - Fax:832-595-2290
Practice Address - Street 1:17320 W GRAND PKWY S STE B
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2667
Practice Address - Country:US
Practice Address - Phone:832-595-2505
Practice Address - Fax:832-595-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00001727583OtherUNITED CONCORDIA