Provider Demographics
NPI:1023001773
Name:LIN, SUN TIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUN TIEN
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LIBERTY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1114
Mailing Address - Country:US
Mailing Address - Phone:413-788-4321
Mailing Address - Fax:413-788-8877
Practice Address - Street 1:125 LIBERTY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1114
Practice Address - Country:US
Practice Address - Phone:413-788-4321
Practice Address - Fax:413-788-8877
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2011-08-31
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MA74569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110054873/AMedicaid
MA110054873/AMedicaid