Provider Demographics
NPI:1417214313
Name:LIN, WONCHON (MD)
Entity Type:Individual
Prefix:
First Name:WONCHON
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5380 S RAINBOW BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1878
Mailing Address - Country:US
Mailing Address - Phone:702-570-2820
Mailing Address - Fax:831-604-0306
Practice Address - Street 1:5380 S RAINBOW BLVD STE 108
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1878
Practice Address - Country:US
Practice Address - Phone:702-570-2820
Practice Address - Fax:831-604-0306
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA128895207W00000X, 207WX0120X
NV17092207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist