Provider Demographics
NPI:1003991688
Name:LIN, AUGUSTIN A (DO)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTIN
Middle Name:A
Last Name:LIN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:3817 GRAND AVE STE B
Mailing Address - Street 2:PMB 225
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5443
Mailing Address - Country:US
Mailing Address - Phone:909-396-1755
Mailing Address - Fax:909-396-8268
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE #120
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-396-1755
Practice Address - Fax:909-396-8268
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA20A6462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH13734Medicare UPIN