Provider Demographics
NPI:1700170453
Name:LIN, TERRY YI-KUNG (DDS, MS, FACP)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:YI-KUNG
Last Name:LIN
Suffix:
Gender:M
Credentials:DDS, MS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7370
Mailing Address - Country:US
Mailing Address - Phone:212-758-5858
Mailing Address - Fax:
Practice Address - Street 1:570 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7370
Practice Address - Country:US
Practice Address - Phone:212-758-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555161223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics