Provider Demographics
NPI:1285683920
Name:LIN, PARKSON JIANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PARKSON
Middle Name:JIANN
Last Name:LIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2 HUGHES
Mailing Address - Street 2:STE 150
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2036
Mailing Address - Country:US
Mailing Address - Phone:949-551-5882
Mailing Address - Fax:949-600-8264
Practice Address - Street 1:2 HUGHES
Practice Address - Street 2:STE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2036
Practice Address - Country:US
Practice Address - Phone:949-551-5882
Practice Address - Fax:949-600-8264
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAE3792213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3792BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAU33541Medicare UPIN