MEDICARE: BENJAMIN JONG-BIN 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	C36574	CA

General Provider Information

NPI Number	:	1386912921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JONG-BIN LIN D.D.S.

Provider Business Mailing Address
First Line	:	9870 HIBERT ST STE D12
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1091
Country	:	US
Telephone Number	:	858-566-3688
Fax Number	:

Provider Business Practice Location Address
First Line	:	9870 HIBERT ST STE D12
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-1091
Country	:	US
Telephone Number	:	858-566-3688
Fax Number	:

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

Provider Enumeration Date	:	12/11/2011
Last Update Date	:	12/11/2011

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