Provider Demographics
NPI:1164554382
Name:LIN, JUDDY KING-YO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDDY
Middle Name:KING-YO
Last Name:LIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 W TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-6817
Mailing Address - Country:US
Mailing Address - Phone:909-620-6066
Mailing Address - Fax:
Practice Address - Street 1:3080 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPS RANCH
Practice Address - State:CA
Practice Address - Zip Code:91766-6817
Practice Address - Country:US
Practice Address - Phone:909-620-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist