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General NPI Number Information
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NPI Number | 1891579173
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Entity Type | Individual
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Provider Name | ELISHA LIN
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Gender | Male
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 255 S GRAND AVE STE 204
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City | LOS ANGELES
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State | CA
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Zip | 90012-3035
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Country | US
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Telephone | 213-863-9464
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Fax |
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Provider Business Mailing Address
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Address Line | 332 W PEBBLE BEACH LN
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City | AZUSA
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State | CA
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Zip | 91702-1440
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Country | US
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Telephone | 808-392-1646
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 107964
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License Number State | CA
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