Healthcare Provider Details

I. General information

NPI: 1518709278
Provider Name (Legal Business Name): JASON LIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25-15 BROADWAY
FAIR LAWN NJ
07410-3813
US

IV. Provider business mailing address

1661 MADISON AVE APT 3A
NEW YORK NY
10029-0363
US

V. Phone/Fax

Practice location:
  • Phone: 201-254-2969
  • Fax:
Mailing address:
  • Phone: 347-217-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI03146300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: