Provider Demographics
NPI:1265832968
Name:LIN, PO-JEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PO-JEN
Middle Name:
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 1:1035 S DE ANZA BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2772
Mailing Address - Country:US
Mailing Address - Phone:408-252-4850
Mailing Address - Fax:408-252-4339
Practice Address - Street 1:1035 S DE ANZA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2772
Practice Address - Country:US
Practice Address - Phone:408-252-4850
Practice Address - Fax:408-252-4339
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice