=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437463312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOKLINE ORTHODONTIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2010
-----------------------------------------------------
Last Update Date | 08/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 BOYLSTON ST # 2-104
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-7600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-566-1775
-----------------------------------------------------
Fax | 617-731-6131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 323 BOYLSTON ST # 2-104
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02445-7600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-566-1775
-----------------------------------------------------
Fax | 617-731-6131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DMD
-----------------------------------------------------
Name | DR. YUNG LIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-686-0372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 20085
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------