MEDICARE: MARIAN TZU MIAO LIN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00009812	WA
2	1223G0001X	General Practice Dentistry	DDS105814	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275521072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN TZU MIAO LIN D.D.S.

Provider Business Mailing Address
First Line	:	8312 E. TRUCKEE WAY
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	425-214-3670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 W. RENAISSANCE PKWY
Second Line	:	UNIT 240
City	:	RIALTO
State	:	CA
Zip	:	92376
Country	:	US
Telephone Number	:	909-746-5000
Fax Number	:	310-820-0408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/11/2021

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