Provider Demographics
NPI:1821008251
Name:LIN, KIMBERLY HUYEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:HUYEN
Last Name:LIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 LOWELL ST
Mailing Address - Street 2:#2206
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4501
Mailing Address - Country:US
Mailing Address - Phone:617-505-4172
Mailing Address - Fax:
Practice Address - Street 1:311 LOWELL ST
Practice Address - Street 2:#2206
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4501
Practice Address - Country:US
Practice Address - Phone:617-505-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice