Provider Demographics
NPI:1699016576
Name:LIN, KEVIN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:K
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 1:886 HILGARD AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3155
Mailing Address - Country:US
Mailing Address - Phone:310-909-9668
Mailing Address - Fax:
Practice Address - Street 1:886 HILGARD AVE
Practice Address - Street 2:APT 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3155
Practice Address - Country:US
Practice Address - Phone:310-909-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist