1275521072 NPI number — MARIAN TZU MIAO LIN D.D.S.

Table of content: CASEY PARTIZ (NPI 1922513068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275521072 NPI number — MARIAN TZU MIAO LIN D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIN
Provider First Name:
MARIAN
Provider Middle Name:
TZU MIAO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275521072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8312 E. TRUCKEE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-214-3670
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 W. RENAISSANCE PKWY
Provider Second Line Business Practice Location Address:
UNIT 240
Provider Business Practice Location Address City Name:
RIALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-746-5000
Provider Business Practice Location Address Fax Number:
310-820-0408
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DE00009812 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DDS105814 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5049036 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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