Provider Demographics
NPI:1326158635
Name:HAROLD M LIN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HAROLD M LIN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-594-6693
Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:SUITE105
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2000
Mailing Address - Country:US
Mailing Address - Phone:562-594-6693
Mailing Address - Fax:562-596-9703
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:SUITE105
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2000
Practice Address - Country:US
Practice Address - Phone:562-594-6693
Practice Address - Fax:562-596-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22091Medicare PIN