Provider Demographics
NPI:1396869137
Name:CHAN, LIN S
Entity type:Individual
Prefix:DR
First Name:LIN
Middle Name:S
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S GARFIELD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3895
Mailing Address - Country:US
Mailing Address - Phone:626-642-0288
Mailing Address - Fax:626-642-0297
Practice Address - Street 1:333 S GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3895
Practice Address - Country:US
Practice Address - Phone:626-642-0288
Practice Address - Fax:626-642-0297
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD538981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD53898OtherDENTISTRY