Provider Demographics
NPI:1033210901
Name:LIN, THOMAS HT (MEDICAL DIRECTOR)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HT
Last Name:LIN
Suffix:
Gender:M
Credentials:MEDICAL DIRECTOR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 93723
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91715-3723
Mailing Address - Country:US
Mailing Address - Phone:626-308-0068
Mailing Address - Fax:626-810-2189
Practice Address - Street 1:725 S ATLANTIC BLVD STE H
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-3856
Practice Address - Country:US
Practice Address - Phone:626-576-9929
Practice Address - Fax:626-576-2959
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA64211207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A642110Medicaid
CA95-44848047OtherTAX ID#
CAA64211OtherSTATE LIC#