MEDICARE: DR. ANGELA LIN D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	48144	CA

General Provider Information

NPI Number	:	1558588954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA LIN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	260 KING ST APT 807
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-6423
Country	:	US
Telephone Number	:	415-902-9397
Fax Number	:	415-777-1107

Provider Business Practice Location Address
First Line	:	260 KING ST APT 807
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-6423
Country	:	US
Telephone Number	:	415-902-9397
Fax Number	:	415-777-1107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/14/2007

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