Provider Demographics
NPI:1215084074
Name:LIN, JAMES P (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:LIN
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 1:15030 VENTURA BLVD UNIT #9
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-849-5195
Mailing Address - Fax:818-948-5578
Practice Address - Street 1:15030 VENTURA BLVD UNIT #9
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-849-5195
Practice Address - Fax:818-849-5578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICSDT 24122300000X
CA60251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist