Provider Demographics
NPI:1235716523
Name:LIN, SONYA (DDS)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 HOLLYWOOD BLVD UNIT 1226
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5365
Mailing Address - Country:US
Mailing Address - Phone:925-858-0171
Mailing Address - Fax:
Practice Address - Street 1:1755 ERRINGER RD STE 20
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6507
Practice Address - Country:US
Practice Address - Phone:805-522-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1071231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry