Provider Demographics
NPI:1104478155
Name:SHEN, LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:SHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E SOUTH ST UNIT 471
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7608
Mailing Address - Country:US
Mailing Address - Phone:215-200-6434
Mailing Address - Fax:
Practice Address - Street 1:1195 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3202
Practice Address - Country:US
Practice Address - Phone:951-339-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1039791223G0001X
MADN18587761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice