Provider Demographics
NPI:1417016445
Name:TRI VALLEY CARDIOLOGY MEDICAL OFFICE
Entity Type:Organization
Organization Name:TRI VALLEY CARDIOLOGY MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-734-0712
Mailing Address - Street 1:5565 W LAS POSITAS BLVD
Mailing Address - Street 2:#300
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588
Mailing Address - Country:US
Mailing Address - Phone:925-734-0712
Mailing Address - Fax:925-734-9816
Practice Address - Street 1:5565 W LAS POSITAS BLVD
Practice Address - Street 2:#300
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-734-0712
Practice Address - Fax:925-734-9816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110245859OtherRR MEDICARE
CAOOA52480Medicaid
G90109Medicare UPIN
OOA524800Medicare ID - Type Unspecified
ZZZ234702Medicare ID - Type UnspecifiedGR #