Healthcare Provider Details

I. General information

NPI: 1609483890
Provider Name (Legal Business Name): JAMES LIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 TELEGRAPH AVE
BERKELEY CA
94705-2049
US

IV. Provider business mailing address

2502 LAS GALLINAS AVE
SAN RAFAEL CA
94903-1423
US

V. Phone/Fax

Practice location:
  • Phone: 510-259-8489
  • Fax:
Mailing address:
  • Phone: 510-259-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS107345
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1002447
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: