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Provider Information for 1053793893

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. FREDERICK LIN D.M.D.

Gender: MALE

Individual NPI: 1053793893

Calendar   Last Updated:  2020-09-02
  Certification Date:  2020-09-02

Details

Name Value
NPI 1053793893
Enumeration Date 2015-06-28
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 4314 E LONE CACTUS DR
PHOENIX, AZ 85050-6888
United States

Phone: 925-262-3069 | Fax:
View Map External Link
Primary Practice Address 4022 E GREENWAY RD STE 12
PHOENIX, AZ 85032-4799
United States

Phone: 602-457-4788 | Fax:
View Map External Link
Secondary Practice Address 13660 N 94TH DR SUITE B-1
PEORIA, AZ 85381-4836
United States

Phone: 623-977-2551 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist AZ D009245
No 1223G0001X - Dentist General Practice AZ D009245