=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003012329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINH N VAN DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1667 DOMINICAN WAY SUITE 232
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95065-1518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-476-5512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1667 DOMINICAN WAY SUITE 232
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95065-1518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-476-5512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LINH N. VAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 415-902-0226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 50389
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------