Provider Demographics
NPI:1679584270
Name:LIN, JOHN S (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:LIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 HARBOR BLVD
Mailing Address - Street 2:STE. A-3
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5830
Mailing Address - Country:US
Mailing Address - Phone:714-638-7554
Mailing Address - Fax:714-638-8322
Practice Address - Street 1:12901 HARBOR BLVD
Practice Address - Street 2:STE. A-3
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5830
Practice Address - Country:US
Practice Address - Phone:714-638-7554
Practice Address - Fax:714-638-8322
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice