MEDICARE: KYLE SHIH-KAE LIN

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	104336	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223G0001X	General Practice Dentistry	CSDT-109	HI

General Provider Information

NPI Number	:	1902301021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE SHIH-KAE LIN

Provider Business Mailing Address
First Line	:	15902 EL CAMINO ENTRADA
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2162
Country	:	US
Telephone Number	:	858-442-1737
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	:	03/29/2018
Last Update Date	:	09/29/2022

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