Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019030855 | IL |
NPI | 1003360272 |
---|---|
Provider Name | Shawn Lin |
First Address | Chicago, IL 60616-3501 |
Second Address | Chicago, IL 60616-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2016 |
Last Update Date | 07/03/2018 |