MEDICARE: LIN-YUN-HU DENTAL CORPORATION

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	1223G0001X	General Practice Dentistry	44185	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B-44185-03	OTHER		HEALTHY FAMILIES
2	B-44185-02	OTHER	CA	MEDICAL
3	827247	OTHER	CA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1598965816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIN-YUN-HU DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	212 S ATLANTIC BLVD
Second Line	:	SUITE 103
City	:	EAST LOS ANGELES
State	:	CA
Zip	:	90022-1754
Country	:	US
Telephone Number	:	323-722-6600
Fax Number	:	323-722-6664

Provider Business Practice Location Address
First Line	:	212 S ATLANTIC BLVD
Second Line	:	SUITE 103
City	:	EAST LOS ANGELES
State	:	CA
Zip	:	90022-1754
Country	:	US
Telephone Number	:	323-722-6600
Fax Number	:	323-722-6664

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. LIN YUN HU
Credential	:	DDS
Telephone Number	:	323-722-6600

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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