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General NPI Number Information
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NPI Number | 1972885002
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Entity Type | Individual
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Provider Name | MARCUS LIN DDS
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Gender | Male
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 29300 KOHOUTEK WAY
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City | UNION CITY
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State | CA
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Zip | 94587
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Country | US
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Telephone | 510-324-4411
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Fax | 510-324-4711
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Provider Business Mailing Address
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Address Line | P.O. BOX 157
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City | UNION CITY
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State | CA
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Zip | 94587
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Country | US
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Telephone | 510-324-4411
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Fax | 510-324-4711
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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 | 054181
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License Number State | NY
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Taxonomy #2
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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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