Provider Demographics
NPI:1417975392
Name:LIN, ROSE HWEI-DA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:HWEI-DA
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4077 5TH AVE
Mailing Address - Street 2:MER 35, DEPARTMENT OF MEDICAL EDUCATION
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2105
Mailing Address - Country:US
Mailing Address - Phone:619-626-3802
Mailing Address - Fax:
Practice Address - Street 1:1831 WILSHIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5778
Practice Address - Country:US
Practice Address - Phone:310-829-8584
Practice Address - Fax:424-291-4205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90043207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine