Provider Demographics
NPI:1104863224
Name:LIN, CHI-HSIUNG (MD)
Entity Type:Individual
Prefix:
First Name:CHI-HSIUNG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:C
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3674
Mailing Address - Country:US
Mailing Address - Phone:908-965-0234
Mailing Address - Fax:908-965-1191
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 506
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-965-0234
Practice Address - Fax:908-965-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3824306Medicaid
NJ159546Medicare UPIN