Provider Demographics
NPI:1659564466
Name:LIN, MICHAEL CHIH-SHUN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHIH-SHUN
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 1:333 W EL CAMINO REAL STE 290
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-8127
Mailing Address - Country:US
Mailing Address - Phone:408-730-5252
Mailing Address - Fax:
Practice Address - Street 1:333 W EL CAMINO REAL STE 290
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-8127
Practice Address - Country:US
Practice Address - Phone:408-730-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist