Provider Demographics
NPI:1235587494
Name:LIN, RICHARD LEE-TSONG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE-TSONG
Last Name:LIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 196TH ST SW
Mailing Address - Street 2:UNIT 2058
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-3202
Mailing Address - Country:US
Mailing Address - Phone:360-814-6451
Mailing Address - Fax:
Practice Address - Street 1:3823 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7735
Practice Address - Country:US
Practice Address - Phone:360-814-6800
Practice Address - Fax:360-814-6904
Is Sole Proprietor?:No
Enumeration Date:2016-05-28
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X, 390200000X
WAMD60971388207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60971388OtherWA STATE MEDICAL LICENSE
WA2161323Medicaid