Healthcare Provider Details

I. General information

NPI: 1174000186
Provider Name (Legal Business Name): LIN SEBAIHI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 N 19TH AVE
MELROSE PARK IL
60160
US

IV. Provider business mailing address

4849 N MILWAUKEE AVE STE 403
CHICAGO IL
60630-2169
US

V. Phone/Fax

Practice location:
  • Phone: 708-665-8588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.031870
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: