MEDICARE: DR. VINCENT I-SUN 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	019-026119	IL

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	:	1760473839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT I-SUN LIN D.D.S.

Provider Business Mailing Address
First Line	:	133 RUMSEY PL
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-2650
Country	:	US
Telephone Number	:	630-701-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 75TH ST
Second Line	:	B1
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516
Country	:	US
Telephone Number	:	630-969-6688
Fax Number	:

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/20/2011

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