Provider Demographics
NPI:1407966500
Name:LIN, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:8008 MONET AVENUE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8890
Mailing Address - Country:US
Mailing Address - Phone:909-463-6900
Mailing Address - Fax:909-463-1430
Practice Address - Street 1:8008 MONET AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-7509
Practice Address - Country:US
Practice Address - Phone:909-463-6900
Practice Address - Fax:909-463-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-01-11
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Provider Licenses
StateLicense IDTaxonomies
CAA70227207K00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96167Medicare UPIN