Provider Demographics
NPI:1467882852
Name:MARCUS LIN, DDS, INC.
Entity Type:Organization
Organization Name:MARCUS LIN, DDS, INC.
Other - Org Name:KOHOUTEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-285-1174
Mailing Address - Street 1:29300 KOHOUTEK WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1252
Mailing Address - Country:US
Mailing Address - Phone:347-285-1174
Mailing Address - Fax:
Practice Address - Street 1:29300 KOHOUTEK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1252
Practice Address - Country:US
Practice Address - Phone:347-285-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty