Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 49366 | CA |
NPI | 1124159017 |
---|---|
Provider Name | Dr. James Lin |
First Address | Culver City, CA 90232-4019 |
Second Address | Harbor City, CA 90710-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 04/11/2013 |