Provider Demographics
NPI:1467472472
Name:LIN, HAROLD M (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:M
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3791 KATELLA AVE
Mailing Address - Street 2:SUITE 105
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:SUITE 105
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA29948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A299480Medicaid
CA00A299480Medicaid
CAA25921Medicare UPIN