Provider Demographics
NPI:1205846763
Name:LIN, CYNTHIA SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SHANNON
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:SHANNON
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2020 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4219
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:858-616-8258
Practice Address - Street 1:2020 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4219
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:858-616-8258
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A622440Medicaid
CAWA62244AMedicare ID - Type Unspecified
CAG79903Medicare UPIN