Provider Demographics
NPI:1558588954
Name:LIN, ANGELA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 KING ST APT 807
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-6423
Mailing Address - Country:US
Mailing Address - Phone:415-902-9397
Mailing Address - Fax:415-777-1107
Practice Address - Street 1:260 KING ST APT 807
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-6423
Practice Address - Country:US
Practice Address - Phone:415-902-9397
Practice Address - Fax:415-777-1107
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics