Provider Demographics
NPI:1275631954
Name:LIN, MAU SHONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MAU SHONG
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 NORTH VIRGINIA STREET
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979
Mailing Address - Country:US
Mailing Address - Phone:361-552-2906
Mailing Address - Fax:361-552-2344
Practice Address - Street 1:1706 NORTH VIRGINIA STREET
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979
Practice Address - Country:US
Practice Address - Phone:361-552-2906
Practice Address - Fax:361-552-2344
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6007207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110532202Medicaid
C18431Medicare UPIN
TX00KB66Medicare ID - Type Unspecified