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General NPI Number Information
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NPI Number | 1467882852
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Entity Type | Organization
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Legal Business Name | MARCUS LIN, DDS, INC.
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 29300 KOHOUTEK WAY SUITE 100
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City | UNION CITY
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State | CA
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Zip | 94587-1252
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Country | US
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Telephone | 347-285-1174
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Fax |
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Provider Business Mailing Address
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Address Line | 29300 KOHOUTEK WAY SUITE 100
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City | UNION CITY
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State | CA
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Zip | 94587-1252
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Country | US
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Telephone | 347-285-1174
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. MARCUS LIN
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Credential | DDS
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Telephone | 347-285-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61976
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License Number State | CA
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