Healthcare Provider Details

I. General information

NPI: 1710330972
Provider Name (Legal Business Name): KEN LIN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WALNUT ST SUITE 402
PHILADELPHIA PA
19102-2944
US

IV. Provider business mailing address

1601 WALNUT ST SUITE 402
PHILADELPHIA PA
19102-2944
US

V. Phone/Fax

Practice location:
  • Phone: 215-972-0181
  • Fax: 215-563-7288
Mailing address:
  • Phone: 215-972-0181
  • Fax: 215-563-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS037841
License Number StatePA

VIII. Authorized Official

Name: DR. KEN LIN
Title or Position: OWNER
Credential: DMD
Phone: 215-972-0181