Provider Demographics
NPI:1609886811
Name:LIN, MICHAEL CHING MAO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHING MAO
Last Name:LIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30814 COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA
Mailing Address - State:CA
Mailing Address - Zip Code:92651-8136
Mailing Address - Country:US
Mailing Address - Phone:949-499-1200
Mailing Address - Fax:949-499-2266
Practice Address - Street 1:30814 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA
Practice Address - State:CA
Practice Address - Zip Code:92651-8136
Practice Address - Country:US
Practice Address - Phone:949-499-1200
Practice Address - Fax:949-499-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist