MEDICARE: SIYAN LIN DDS

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	122300000X	Dentist	055777	NY
2	1223P0300X	Periodontics	055777	NY

General Provider Information

NPI Number	:	1396025177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIYAN LIN DDS

Provider Business Mailing Address
First Line	:	3307 91ST ST APT 5K
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1710
Country	:	US
Telephone Number	:	347-585-6305
Fax Number	:

Provider Business Practice Location Address
First Line	:	3307 91ST ST APT 5K
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1710
Country	:	US
Telephone Number	:	347-585-6305
Fax Number	:

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

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/22/2024

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Directions to “ SIYAN LIN DDS” Practice Location

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