MEDICARE: KEVIN S. LIN D.M.D.

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	DN1857403	MA
2	1223P0300X	Periodontics	103835	CA

General Provider Information

NPI Number	:	1902351836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN S. LIN D.M.D.

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	:
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	:	08/21/2016
Last Update Date	:	07/17/2019

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