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General NPI Number Information
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NPI Number | 1609483890
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Entity Type | Individual
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Provider Name | JAMES LIN
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Gender | Male
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 404 SAN PABLO TOWNE CENTER
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City | SAN PABLO
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State | CA
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Zip | 94806
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Country | US
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Telephone | 510-236-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 COURT ST APT 220
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2969
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Country | US
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Telephone | 510-259-8489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1002447
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS107345
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License Number State | CA
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