Healthcare Provider Details

I. General information

NPI: 1699389460
Provider Name (Legal Business Name): LIN THU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 LOMITA BLVD
HARBOR CITY CA
90710-2024
US

IV. Provider business mailing address

7724 W 85TH ST
PLAYA DEL REY CA
90293-8406
US

V. Phone/Fax

Practice location:
  • Phone: 213-263-6764
  • Fax:
Mailing address:
  • Phone: 626-497-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number105388
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number105388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: