Provider Demographics
NPI:1154420941
Name:LIN, LOUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 W LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1600
Mailing Address - Country:US
Mailing Address - Phone:310-326-6668
Mailing Address - Fax:310-326-6669
Practice Address - Street 1:2146 W LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1600
Practice Address - Country:US
Practice Address - Phone:310-326-6668
Practice Address - Fax:310-326-6669
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice