Provider Demographics
NPI:1336439785
Name:LIN, NINA DIEM (DMD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:DIEM
Last Name:LIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:DIEM
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1964 WESTWOOD BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8402
Mailing Address - Country:US
Mailing Address - Phone:310-441-0385
Mailing Address - Fax:
Practice Address - Street 1:1964 WESTWOOD BLVD STE 340
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8402
Practice Address - Country:US
Practice Address - Phone:310-441-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61734122300000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program