Provider Demographics
NPI:1275551251
Name:LIN, JAY JENSHONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:JENSHONG
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22030 SHERMAN WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1885
Mailing Address - Country:US
Mailing Address - Phone:818-883-6840
Mailing Address - Fax:818-883-8828
Practice Address - Street 1:22030 SHERMAN WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1855
Practice Address - Country:US
Practice Address - Phone:818-883-6840
Practice Address - Fax:818-883-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA31426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA31426Medicare ID - Type Unspecified
CAA26474Medicare UPIN