Provider Demographics
NPI:1073390571
Name:LIN, JOHN RYAN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RYAN
Last Name:LIN
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 1:1039 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1823
Mailing Address - Country:US
Mailing Address - Phone:312-519-5470
Mailing Address - Fax:
Practice Address - Street 1:1039 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1823
Practice Address - Country:US
Practice Address - Phone:312-519-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program