Provider Demographics
NPI:1316507742
Name:LIN, KEVIN SUNG-YAO (DMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SUNG-YAO
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 1:2558 S ANAHEIM ST UNIT P301
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1477
Mailing Address - Country:US
Mailing Address - Phone:858-342-1688
Mailing Address - Fax:
Practice Address - Street 1:2558 S ANAHEIM ST UNIT P301
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1477
Practice Address - Country:US
Practice Address - Phone:858-342-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty