Provider Demographics
NPI:1184753873
Name:LIN, LORRAINE YEN YEN (DDS)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:YEN YEN
Last Name:LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11965 PELLICANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6829
Mailing Address - Country:US
Mailing Address - Phone:619-296-4133
Mailing Address - Fax:
Practice Address - Street 1:11965 PELLICANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6829
Practice Address - Country:US
Practice Address - Phone:858-966-4094
Practice Address - Fax:858-966-8097
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51281Medicaid
TX205109601Medicaid