Provider Demographics
NPI:1326044819
Name:LYNN, PHILIP ARL (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ARL
Last Name:LYNN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:14411 BROOKHURST ST
Mailing Address - Street 2:STE D
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4667
Mailing Address - Country:US
Mailing Address - Phone:714-839-4545
Mailing Address - Fax:714-839-3236
Practice Address - Street 1:14411 BROOKHURST ST
Practice Address - Street 2:STE D
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4667
Practice Address - Country:US
Practice Address - Phone:714-839-4545
Practice Address - Fax:714-839-3236
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG66511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G665111Medicaid
CA330758533OtherTAX ID
CA00G665111Medicaid