Healthcare Provider Details

I. General information

NPI: 1891572368
Provider Name (Legal Business Name): SOPHIA LIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14858 N FRANK LLOYD WRIGHT BLVD STE 165A
SCOTTSDALE AZ
85260-2216
US

IV. Provider business mailing address

14858 N FRANK LLOYD WRIGHT BLVD STE 165A
SCOTTSDALE AZ
85260-2216
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-4455
  • Fax:
Mailing address:
  • Phone: 480-860-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: