Provider Demographics
NPI:1144501123
Name:LYNN, MIN
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:
Last Name:LYNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1339
Mailing Address - Country:US
Mailing Address - Phone:510-744-0844
Mailing Address - Fax:
Practice Address - Street 1:4075 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1339
Practice Address - Country:US
Practice Address - Phone:510-744-0844
Practice Address - Fax:510-744-0484
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice